Program_Memos / 2003 / AB-03-083

Why This Topic Matters

The memorandum affects how Medicare complaint allegations are handled operationally and how contractor responsibilities are divided. It is useful for organizations managing Medicare program integrity workflows, inquiry processing, and tracking requirements.

Article Sections

1. Purpose and Scope

   Introduces the memorandum and explains the contractor populations and program integrity functions addressed by the guidance.

2. Medicare Fee-for-Service Contractor Responsibilities

   Describes initial complaint handling, screening responsibilities, and general categories of issues that may be resolved or routed for further review.

3. Initial Screening

   Covers front-end inquiry handling and examples of complaint types that may be evaluated during first contact.

4. Second Level Screening

   Summarizes the more detailed review process, referral criteria, documentation gathering, and escalation pathways within contractor operations.

5. Medicare Fee-For-Service Contractor BIU and PSC Responsibilities

   Outlines the downstream responsibilities for further development, acknowledgment, referrals, and tracking after a complaint is received by integrity staff.