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End-Stage Renal Disease Eligibility and Evidence Report

Date: 06/20/24

Wellcare By Allwell would like to share important information about End-Stage Renal Disease (ESRD) with providers.

According to CMS guidelines for ESRD, candidate eligibility is determined by:

  • The first day of the third month after the month dialysis begins (i.e., the first day of the fourth month of dialysis), demonstrated by claims submissions;
  • The first day of the month dialysis began, if the individual trains for self-dialysis;
  • The month an individual is admitted to a hospital for a kidney transplant, or for health care services needed before a transplant, if the transplant takes place in the same month or within the two following months.

In addition, for a Medicare beneficiary to be assigned an ESRD status, the attending physician must certify the ESRD status of the enrollee by completing a CMS Form CMS-2728-U3. This form must be submitted electronically through the CMS MyCROWNWeb website.

Tips for Submitting Eligibility & Evidence Report (2728 Form)

Submission of the CMS End Stage Renal Disease Medical Evidence Report Medicare Entitlement And/Or Patient Registration (also known as the CMS-2728-U3 form) is required for a members ESRD eligibility.

The form must be submitted through or completed in the End-Stage Renal Disease (ESRD) Quality Reporting System (EQRS) Portal within the CMS MyCROWNWeb website. Please ensure the following key data elements are included and accurate:

  • ESRD chronic date is listed in MyCROWNWeb, reflecting the date ESRD was diagnosed;
    • Ensure this date coincides with claim date of service.
  • Ensure the member’s current Medicare ID or Medicare Beneficiary Identifier is listed in EQRS.
  • Ensure the patient and doctor signature dates are listed;
    • CMS-2746 ESRD Death Notification Form is required if a patient expires.
  • Member’s information is not transmitted to CMS if it is not in “submit” status.

The following resources are available to assist with ESRD candidate and eligibility information:

If you experience issues with submission or identifying a member in MyCROWNWeb, locate your state contact information by accessing the ESRD National Coordinating Center’s ESRD Network Map.

For information specific to the provider’s responsibility to update MyCROWNWeb, please reference the CMS End-Stage Renal Disease (ESRD) Quality Reporting System (EQRS) Data Management Guidelines (PDF).