Medicare Claims Processing Manual (Pub. 100-04), Ch. 33 § 10.9.3

Sufficient Information

Last amended: 2005Year: 2005Length: 183 wordsOfficial source
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.
Medicare Claims Processing Manual (Pub. 100-04), Ch. 33 § 10.9.3: Sufficient Information | Justis AI