System and Processing Requirements for Use of Secure Internet

10.13 – System and Processing Requirements for Use of Secure Internet Portal/Application to Support Reopening Activities (Rev. 2241; Issued: 06-17-11, Effective: 10-01-11, Implementation: 10-03-11) Contractors who develop and utilize a secure Internet portal/application for reopening purposes shall ensure, at a minimum: • CMS approves (i.e., Contract Manager or Project Officer, if applicable, and Appeals Business Function Lead) the proposed portal/application and usage prior to development and implementation. • The portal/application fully complies and has been tested to ensure compliance with all CMS system security requirements regarding protected health information prior to implementation/usage. • The secure Internet portal/application includes a formal registration process that validates the signature. This process shall include, at a minimum, use of restricted user identifiers (IDs) and passwords. Contractors shall include an indication and/or description of the validation methodology in the appeals case file should an appeal on the item/service reopened be requested. • Templates for submission of electronic reopening request shall include, at a minimum, a method for authenticating that the party has completed the portal/application registration process and has been properly identified by the system as an appropriate user. • Contractors utilizing an approved portal/application shall provide education to parties to the reopening regarding system capabilities/limitations prior to implementation and utilization of the secure portal/application. • Contractors shall also educate parties to the reopening that participation/enrollment in the secure portal/application is at the discretion of the party and the party bears the responsibility for the authenticity of the information being attested to. • Appropriate procedures are in place to provide parties with confirmation of receipt of the reopening request via secure Internet/portal and verbiage instructing the parties not to submit additional reopening requests for the same item or service via different venue (hard copy mail or telephone). • Contractors utilizing a secure portal/application shall ensure that there is a process in place by which a party can submit additional documentation/materials concurrent with the reopening request. The portal/application shall have the capability to accept additional documentation and/or other materials to support reopening requests. • Refusal to reopen and adverse revised determination notices transmitted via a secure Internet portal/application shall comply with the timeliness and content requirements as outlined in the Pub. 100-04, chapter 34. In addition, contractors shall provide hard copy decision notices to parties to the reopening, as required, who do not have access to the secure Internet portal/application. The notices must be mailed and/or otherwise transmitted concurrently (i.e., mailed on the same day the notice is transmitted via the secure portal/application). • Contractors utilizing a secure Internet portal/application shall include the adverse revised determination/decision notice and any other related materials in the appeals case file if a valid appeal on the item/service is later requested. • Contractors shall also ensure that parties may save and print the revised adverse determination/decision notice or refusal to reopen notice and that the secure portal/application includes a mechanism by which the date/time of the notification is tracked/marked both in the system and on any printed decision notices so as to adequately inform the party of timeframes for ensuring timely submission of future appeal requests.