Time - Frames for Submission

3.2.3.2 - Time - Frames for Submission (Rev. 13821; Issued:06-09-26; Effective: 02-26-26; Implementation: 02-26-26) A. Prepayment Review Time Frames When requesting documentation for prepayment review, the MACs and UPICs shall notify providers when they expect documentation to be received. Per 42 CFR § 405.903, providers and suppliers have 45 calendar days to submit additional documentation in response to a MAC, RAC, or SMRC request. Providers and suppliers have 30 calendar days to respond to a UPIC request. Contractors may accept documentation received after the 45 and 30-calendar day (for UPICs) time frames for good cause. Good cause means situations such as natural disasters, interruptions in business practices, or other extenuating circumstances that the contractor deems good cause in accepting the documentation. Per 42 CFR § 405.930, reviewers shall deny claims when the requested documentation to support payment is not received by the expected time frame. B. Post-payment Review Time Frames When requesting documentation for post-payment review, the MACs, CERT, SMRC, UPICs and RACs shall notify providers when they expect documentation to be received. Per 42 CFR § 405.929, providers and suppliers have 45 calendar days to submit additional documentation in response to a MAC, RAC, SMRC or CERT request. Providers and suppliers have 30 calendar days to respond to a UPIC request. Contractors may accept documentation received after the 45 and 30-calendar day (for UPICs) time frames for good cause. Good cause means situations such as natural disasters, interruptions in business practices, or other extenuating circumstances that the contractor deems good cause in accepting the documentation. Per 42 CFR § 405.930, contractors shall deny claims when the requested documentation to support payment is not received by the expected time frame (including any applicable extensions). C. For esMD submissions The esMD review contractor shall use the esMD Cloud system receipt date as the date the documentation was received. If the esMD Cloud receipt date is outside of the contractors normal business hours, the following business day shall be used as the receipt date. Contractors shall pull for esMD files and latest transaction status at least every 4 hours (business hours) daily; including a mandatory pulling between the hours of 6-7pm EST daily. If unforeseeable circumstances occur, in which contractors are not technically capable of retrieving documentation in a timely manner due to issues outside of their control, contractors are to notify the esMD Team and can use the date documentation was available to be retrieved once issues have been resolved in the esMD Cloud system. D. Kiteworks Submissions This section applies to the UPICs and the I-MEDIC. When requesting additional documentation for medical review using Kiteworks, if, after no more than two attempts of sending the ADR request via Kiteworks (to include atleast 3 calendar days between attempts for a response), there is no response (i.e., no acknowledgment/download/receipt email is received from Kiteworks), the request shall be sent via certified mail, FedEx, UPS, fax etc.