Medicare Claims Processing Manual (Pub. 100-04), Ch. 33 § 10.9.3
Sufficient Information
10.9.3 - Sufficient Information
(Rev. 739, Issued: 11-01-05, Effective: 07-24-03, Implementation: 01-19-06)
The provider or supplier has the burden of proof and of production of evidence to show
that a §903(c) penalty waiver should be granted in the particular circumstance. However,
the contractor should take notice of any relevant and material fact that is not subject to
reasonable dispute.
The contractor shall make a preliminary evaluation regarding whether the provider or
supplier has submitted sufficient information to permit the contractor to determine
whether all of the remaining seven conditions specified in §10.2 have been met. If the
provider or supplier’s request does not furnish sufficient information to make a
determination on each such condition, the contractor shall advise the provider or supplier
of all deficiencies and allow 45 days for the information to be supplied. If sufficient
information is not supplied within the allotted period, the contractor shall close the
penalty waiver case and proceed with its normal process for considering whether the
penalty should be imposed. However, the contractor may at its sole discretion, grant an
extension of time to supply information.