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Written Assurance Letters
Medicare Claims Processing Manual (Pub 100-04 Ch. 29) 
An assurance letter will be issued when an appeal decision on a Part A claim is fully or partially favorable and the beneficiary was previously held liable. The purpose of the assurance letter is to determine if the provider received payment from the beneficiary or any other source for the appealed services.
You must notify Cahaba within two weeks of the date of the assurance letter whether you have or have not received monies for these services. After we receive your response notifying us that no monies have been received, or that any monies in excess of the Medicare deductible and/or coinsurance have been appropriately refunded, the claim(s) adjustment(s) will be adjudicated.
If a response is not received within two weeks of the date on the assurance letter, the appeal file will be closed without adjudicating the claim adjustment.
Page last updated: May 13, 2010
