I plan to offer new products for only one of the HCPCS codes in my contract. Do I still need to enter products for the other codes?
Yes. When you update Form C for a competitive bidding area (CBA)/product category combination, it will delete all of the information on the Supplier Directory and replace it with the product information you enter on Form C. If you make any updates to a CBA/product category combination, you need to enter all of the products you offer for each of the HCPCS codes on the form.
I have already submitted my form, but I need to make a correction and/or an addition to it. What do I do?
Complete another form with your identifying information at the beginning of the form and then enter only the information that needs to be corrected or added. You do not need to enter all product information again. When you print the form, please indicate on the form that this is a correction/addition to a previously submitted form.
How long do I have to submit corrections?
You may make corrections as long as the updated Form C is received by the CBIC by the deadline. If multiple Form C submissions are received for the same CBA/product category combination, the CBIC will use only the last Form C submission to update the Medicare Supplier Directory.
If your changes are not received by the deadline, they will not be included in the Medicare Supplier Directory update for the quarter. Please ensure you submit a complete Form C within next quarter’s reporting window.
What are the reporting requirements for Form C?
You are required to report all the products you plan to make available in the next quarter for ALL HCPCS codes shown on the form for ALL CBA/product category combinations for which you were awarded a contract. Starting with the quarter ending September 30, 2011, you are no longer required to report on the brands and approximate number of competitively bid items furnished to Medicare beneficiaries during the previous quarter.
Why do I have to fill out Form C?
The Form C quarterly report is required under Article IX of the Medicare DMEPOS competitive bidding contract. We need this information so that we can update the Medicare Supplier Directory, which is used by Medicare beneficiaries, customer service representatives at 1-800-MEDICARE, and referral agents to locate contract suppliers that furnish specific products.
What happens if I don't complete and send the form?
Form C is required under Article IX of the contract. Therefore, if you fail to submit Form C, the contract would be considered breached. This could lead to termination of your contract.
Where can I find my contract number?
You can find your contract number on the first page of the cover letter of your fully executed contract (underneath your company’s address). It is also listed in the upper left corner of Attachments A, B and C of your contract.
How do I report the model and manufacturer for an enteral feeding supply kit?
An enteral feeding supply kit may contain items from different manufacturers with various models. You should report the model and manufacturer information for the dominant item included in the kit.
I don't see my product's model on the list of choices. How can I have it added to the list?
You will need to contact your product's manufacturer and request they submit a Coding Verification Review application to have their product listed on the Medicare Pricing, Data Analysis, and Coding (PDAC) Durable Medical Equipment Coding System (DMECS) website. The applications can be found at www.dmepdac.com. If you need additional information, contact the PDAC’s helpline at 877-735-1326.
How do I save data on the form?
Data entered into Form C does not save. You may enter all required information at one time and then select “View Completed Form and Print.”
You may also choose to enter product information for each single product category and competitive bidding area (CBA) combination and then select “View Completed Form and Print.” You must print each form since this information is not saved.
It is important that you print, sign and send ALL forms to the CBIC by the deadline. You must submit information for all product category and CBA combinations for which you were awarded a contract.
Please remember that you will not be able to make any changes to your information once you proceed to the “PRINT” page. Please review all information and make any changes before you proceed to print. If you use the browser to go back after you are on the print screen, you will need to re-enter all the information.
Can the signature from a company official be a stamp or do you require a hand-written signature?
A stamped signature on a Form C submission is acceptable.
If I am submitting multiple Form C pages, do I need to sign each page?
You have the option of either signing each submitted page or signing a cover page stating that the signature applies to all submitted Form C pages.
Should I fax the form or mail it?
You can either mail or fax the form to the CBIC. However, we recommend that you fax it to the CBIC at
If you choose to mail the form, please send it to:
Competitive Bidding Implementation Contractor
2743 Perimeter Pkwy Ste 200-400
Augusta, GA 30909-6499
Can the form be mailed to the CBIC on the due date, or do I have to send it in time for the CBIC to get it by the due date?
You always need to send the form in time for the CBIC to get it by the due date.
What happens if I send the form in late?
Failure to meet this deadline is considered a breach of contract and could lead to termination of your contract.
How can I find out if the CBIC has received my form? Will I be notified?
You can call the CBIC customer service center at 877-577-5331, and we will verify whether the report has been received.
When can I expect my updated product information to be reflected on the Medicare Supplier Directory?
You should expect to see the updated product information posted within 30 days after the Form C submission deadline.