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Provider Reimbursement Review Board (PRRB) Hearings

PRRB

Part A Providers are guaranteed the right to Appeal (42 USC 1395ooetseq) any "final determination" (NPR) with which they are "dissatisfied", providing the issue meets specific criteria of dissatisfaction, timeliness of appeal (within 180 days) and amount in controversy ($10,000 individual appeal; $50,000 group appeal). The appeal is to the Provider Reimbursement Review Board (PRRB), an independent adjudicating body of DHHS, staffed by the Office of Hearings of CMS, which serves as the "final exhaustion of administrative remedy" (Administrative Procedures Act § 704) for the Provider that allows the Provider to move into the judicial system if appeal is rejected by the PRRB or CMS Administrator (oversight of PRRB). PRRB Rules This link takes you to an external website.

Beginning September 15, 2015 an electronic version of the appeal request and subsequent correspondence should be sent to Federal Specialized Services, LLC (FSS) via email to prrb@fssappeals.com.  This includes, but is not limited to, position papers, jurisdictional challenges, administrative resolutions, and general case related correspondence. In the e-mail subject line, reference the case number first, followed by the case name, followed by the nature of the correspondence. For example: Subject: PRRB Case No. 10-9999; ABC Hospital; Provider Preliminary Position Paper

There is no need to send a paper copy. All correspondence will be retrieved from the prrb@fssappeals.com mailbox, and directed to the appropriate FSS appeals consultant.

In accordance with PRRB Rule 27.6 H regarding confidential information, do not send any Protected Health Information (PHI) or Personally Identifiable Information (PII) to FSS. . Files containing PHI or PII will be returned to the sender by FSS

If filing documents electronically is not an option, correspondence can be set to FSS at the following address:  PRRB Appeals

Federal Specialized Services

1701 S. Racine Avenue

Chicago, IL  60608-4058

A copy of the appeal request and subsequent correspondence should also be sent electronically to  Noridian via e-mail to JEPRRBAppeals@noridian.com.

Hearing

If a provider takes exception to adjustments where the effect on Medicare reimbursement is at least $1,000 but less than $10,000, the provider can request an Intermediary appeal hearing. A MAC appeal hearing is a hearing by officers designated by the MAC. Noridian has chosen Federal Specialized Services, LLC (FSS) to fulfill this function. Beginning September 15, 2015 any Intermediary appeal correspondence should be sent to FSS electronically via email to intermediary@fssappeals.com.

If filling documents electronically is not an option, correspondence can be sent to FSS at the following address: Intermediary Appeals

Federal Specialized Services

1701 S. Racine Avenue

Chicago, IL  60608-4058

A copy of the appeal request and subsequent correspondence should also be sent electronically to  Noridian via e-mail to JEPRRBAppeals@noridian.com.

Last Updated Sep 14, 2015