What you need to know: There is a new location for accessing the Patient Assessment Change Request Forms for the Minimum Data Set (MDS), effective immediately.

• For easy access, the most used form is MDS 3.0 Manual Individual Assessment Correction/Deletion Request.  All Change Request Forms will be retired on the QTSO website.
• Please dispose of any existing hard or electronic copies containing the old address: 1401 50th St. Suite 200.  

About the Change Request Form: Chapter 5 of the RAI Manual v1.18.11 outlines the correction policy for the MDS. For MDS assessments that have been completed, submitted, and accepted in iQIES, facilities should correct any errors necessary to ensure that the information in iQIES accurately reflects the resident’s identification, location, overall clinical status, or payment status.

The type of correction depends on the type of error: 

• A modification request is completed when an MDS has clinical or demographic errors coded on the assessment.
• An inactivation request is completed when an event did not occur (e.g. a Discharge MDS was submitted for a resident who was not actually discharged from the facility).
• A Manual Assessment Correction/Deletion Request is required to correct:
  • Unit Certification or Licensure Designation (Item A0410) 
  • State-assigned facility submission ID (FAC_ID) or State Code (STATE_CD)  
  • Test record submitted as a production record  
  • Record submitted was not for OBRA or Medicare Part A purposes (e.g., a five-day PPS MDS is submitted for a managed care resident) 

It is this last type of correction request that utilizes the forms noted. Facilities must submit completed and signed forms to their State RAI Coordinator/State Automation Coordinator by Certified Mail through the US Postal Service Center.

Questions? Contact the iQIES Service Center by email at iqies@cms.hhs.gov or by phone: (800) 339-9313.

• To create a new ticket online, track an existing ticket, or recover your HARP password account, please use the CCSQ Support Central: Self-Service Portal.