Medicare Financial Management Manual (Pub. 100-06), Ch. 4 § 70.8
Response to Intent to Refer Letter (Rev. 11787; Issued:01-
70.8 - Response to Intent to Refer Letter (Rev. 11787; Issued:01-
19-23; Effective: 04-21-23; Implementation:04-21-23)
Contractors shall respond to any inquiries received as a result of the ITR letter within 15 calendar days of
receipt. If the status of the debt changes based on the communications with the debtor, contractors shall
update all appropriate systems timely.
The ITR letter provides debtors with 60 calendar days to respond. If, by day 61 the debtor has not
responded to the ITR letter, the contractor not utilizing HIGLAS shall refer the debt immediately by using
the Debt Referral Form. For contractors utilizing HIGLAS, the debt will be systematically referred to
Treasury 66 days from the ITR letter date. Debt for which less than full payment was received, or there is
a current repayment agreement that is in default, are eligible for referral for cross servicing and/or TOP.
Where there has been a partial recoupment or collection, but the collection is not the result of a current
extended repayment agreement, the balance (if principal and interest balance is greater than or equal to
$25) shall still be referred for cross servicing and/or TOP. The contractor shall not refer debts to Treasury
that are ineligible for referral or exempt from referral to cross servicing and/or TOP.
Before referring a debt for cross servicing, contractors shall first determine if the debt should be referred
to the Regional Office (RO) for litigation rather than referral to Treasury for cross servicing. If it is
determined that the debt should be litigated, contact the RO for further action.
If the ITR letter is returned as undeliverable, contractors shall follow established procedures to locate a
better address. (See Chapter 4, §§ 10 and 80) If a better address is obtained, the contractor shall send the
provider/supplier a manual ITR notification letter, with the original ITR letter attached, to the better
address. The original ITR letter date shall remain in effect. If the ITR letter is returned as undeliverable
and a better address cannot be located within 10 business days:
• the contractor not utilizing HIGLAS shall refer the debt to Treasury by entering the debt into the
Debt Referral Form 60 calendar days from the date of the original letter.
• the contractor utilizing HIGLAS shall update the status code to ‘LTR-UNDL-ITR.’ HIGLAS will
systematically refer the debt to Treasury 66 days from the ITR letter date.