CBIC - Round 2 - Form C FAQs

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Round 2

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Do I need to sign each page of Form C? No. You are required to only sign within the designated signature block.	05/22/2014
I am purchasing a contract supplier’s business. Who should submit Form C? The supplier that holds the contract with CMS at the time Form C is due should complete and submit Form C. If the purchaser submits Form C before the novation agreement with CMS is finalized, the updates will not be published in the Supplier Directory.	05/22/2014
What happens if I submit my corrections/additions after the deadline for this quarter? If we do not receive your changes by the deadline, we will use the Form C you submitted timely for the Medicare Supplier Directory update for this quarter. Please ensure you submit a complete Form C within next quarter’s reporting window.	05/22/2014
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 Attachment A of your contract.	05/22/2014
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 submit the form, please include a cover sheet specifying that this is a correction/addition to a previously submitted form.	05/21/2014
How long do I have to submit corrections/additions? You must submit changes by the Form C deadline for the quarter.	05/20/2014
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.	04/01/2013
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.	04/01/2013
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.	04/01/2013
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.	04/01/2013
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 803-264-6228. If you choose to mail the form, please send it to: Palmetto GBA Competitive Bidding Implementation Contractor 2743 Perimeter Pkwy Ste 200-400 Augusta, GA 30909-6499	04/01/2013
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.	09/28/2011
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.	09/28/2011
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.	09/28/2011
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.	09/28/2011

last updated on 05/22/2014

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