Provider Enrollment Corrective Action Plan (CAP), Reconsideration, and Rebuttal Decision Tree - JE Part B
Provider Enrollment Corrective Action Plan (CAP), Reconsideration, and Rebuttal Decision Tree
The Provider Enrollment Corrective Action Plan (CAP), Reconsideration, and Rebuttal Decision Tree is a tool that may assist the user in submitting a Provider Enrollment reconsideration request, corrective action plan or rebuttal. The user will be provided a short series of questions to determine what type of submission they may be eligible for and where to send their submission.
Disclaimer: Refer to the initial determination or deactivation letter for applicable corrective action plan, reconsideration request or rebuttal rights, submission requirements, and address information.
Are you a Part B Provider?
Are you appealing a deactivation?
Rebuttals can only be submitted for the following deactivation reasons:
- Non-response to a revalidation request,
- Failure to report a change
- Non-billing
- No valid practice location for 90 days
- Not in compliance with all enrollment requirements
- Practice location is non-operational or otherwise invalid
- The provider/supplier is deceased
- The provider/supplier is voluntarily withdrawing from Medicare
Were you deactivated for one of these reasons?
Are you appealing a rejected or returned application?
A rebuttal must be received within 15 days from the date of the deactivation letter.
Is the date on the letter more than 15 calendar days ago?
You do not have rebuttal rights.
Contact the Provider Enrollment Contact Center for assistance.
Rejected and returned applications do not have appeal rights.
The following supplier types submit their appeals to CMS:
- Ambulatory Surgical Centers
- Independent Laboratories (CLIA Lab)
- Mammography Screening Centers
- Portable X-Ray Suppliers
- Independent Diagnostic Testing Facilities
- Opioid Treatment Programs
- Medicare Diabetes Prevention Programs
Are you one of those supplier types?
Your rebuttal rights have expired. You may reactivate your Medicare enrollment.
You may submit a rebuttal.
Submit your appeal to CMS using the CMS CAP Reconsideration Coversheet.
Are you one of the following supplier types?
- Mass Immunization/Flu Roster Biller
- Ambulance Service Supplier
- Intensive Cardiac Rehabilitation
- Radiation Therapy Center
- Pharmacy
Were you revoked?
Are you appealing a revocation or denial decision?
Were you revoked for non compliance?
Were you denied?
Do you want to submit information to correct the deficiency that caused the revocation or denial?
Are you appealing an effective date or billing lapse?
A CAP must be received within 35 days from the date of the denial letter.
Is the date on the letter more than 35 calendar days ago?
You do not have CAP rights.
Do you want to submit a reconsideration?
Do you want to submit information to correct the deficiency that caused a denial?
Are you appealing an effective date or billing lapse?
A CAP must be received within 35 days from the date of the denial letter.
Is the date on the letter more than 35 calendar days ago?
A reconsideration must be received within 65 days from the date of the initial determination letter.
Is the date on the letter more than 65 calendar days ago?
A reconsideration must be received within 65 days from the date of the initial determination letter.
Is the date on the letter more than 65 calendar days ago?
Are you appealing an Opt Out Period?
Your CAP rights have expired.
Do you want to submit a reconsideration?
Submit your appeal to CMS using the CMS CAP Reconsideration Coversheet.
A reconsideration must be received within 65 days from the date of the initial determination letter.
Is the date on the letter more than 65 calendar days ago?
Contact the Provider Enrollment Contact Center for assistance.
A CAP must be received within 35 days from the date of the denial letter.
Is the date on the letter more than 35 calendar days ago?
A reconsideration must be received within 65 days from the date of the initial determination letter.
Is the date on the letter more than 65 calendar days ago?
A reconsideration must be received within 65 days from the date of the initial determination letter.
Is the date on the letter more than 65 calendar days ago?
Contact the Provider Enrollment Contact Center for assistance.
You do not have CAP rights.
Do you want to submit a reconsideration?
Was the revocation or denial for non-compliance?
Your reconsideration rights have expired.
Contact the Provider Enrollment Contact Center for assistance.
Were you denied for only the following:
- Non-compliance
- False or misleading information
- Failed on-site review
- Payment suspension
- Initial reserve operating funds
- Application fee/hardship exception
- Temporary moratorium
Your reconsideration rights have expired.
Contact the Provider Enrollment Contact Center for assistance.
Submit a reconsideration to Noridian.
Submit your appeal to CMS using the CMS CAP Reconsideration Coversheet.
Contact the Provider Enrollment Contact Center for assistance.
A reconsideration must be received within 65 days from the date of the initial determination letter.
Is the date on the letter more than 65 calendar days ago?
Contact the Provider Enrollment Contact Center for assistance.
Your reconsideration rights have expired.
Contact the Provider Enrollment Contact Center for assistance.
Submit your appeal to CMS using the CMS CAP Reconsideration Coversheet.
Your CAP rights have expired.
Do you want to submit a reconsideration?
Were you denied for non-compliance?
Your reconsideration rights have expired.
Contact the Provider Enrollment Contact Center for assistance.
Were you denied for only the following:
- Non-compliance
- False or Misleading Information
- Failed On-Site Review
- Payment Suspension
- Initial Reserve Operating Funds
- Application Fee/Hardship Exception
- Temporary Moratorium
Your reconsideration rights have expired.
Contact the Provider Enrollment Contact Center for assistance.
Submit a reconsideration to Noridian.
A reconsideration must be received within 65 days from the date of the initial determination letter.
Is the date on the letter more than 65 calendar days ago?
Contact the Provider Enrollment Contact Center for assistance.
Submit a CAP to Noridian. Only the denial or revocation reason of non-compliance will be reviewed.
You do not have CAP rights.
Do you want to submit a reconsideration?
Submit a reconsideration to Noridian.
Were you revoked for only the following:
- Non Compliance
- On-site review
- Grounds related to provider and supplier screening requirements
- Failure to Report
Your reconsideration rights have expired.
Contact the Provider Enrollment Contact Center for assistance.
Submit your appeal to CMS using the CMS CAP Reconsideration Coversheet.
A reconsideration must be received within 65 days from the date of the initial determination letter.
Is the date on the letter more than 65 calendar days ago?
Contact the Provider Enrollment Contact Center for assistance.
Submit a CAP to Noridian. Only the denial reason of non-compliance will be reviewed.
Submit a reconsideration to Noridian.
Submit your appeal to CMS using the CMS CAP Reconsideration Coversheet.
Your reconsideration rights have expired.
Contact the Provider Enrollment Contact Center for assistance.
Submit a reconsideration to Noridian.
A reconsideration must be received within 65 days from the date of the initial determination letter.
Is the date on the letter more than 65 calendar days ago?
Contact the Provider Enrollment Contact Center for assistance.
Submit a reconsideration to Noridian.
Submit your appeal to CMS using the CMS CAP Reconsideration Coversheet.
Your reconsideration rights have expired.
Contact the Provider Enrollment Contact Center for assistance.
Were you denied for only the following:
- Non-compliance
- False or Misleading Information
- Failed On-Site Review
- Payment Suspension
- Initial Reserve Operating Funds
- Application Fee/Hardship Exception
- Temporary Moratorium
Your reconsideration rights have expired.
Contact the Provider Enrollment Contact Center for assistance.
Were you denied for only the following:
- Non-compliance
- False or Misleading Information
- Failed On-Site Review
- Payment Suspension
- Initial Reserve Operating Funds
- Application Fee/Hardship Exception
- Temporary Moratorium
Submit a reconsideration to Noridian.
Submit your appeal to CMS using the CMS CAP Reconsideration Coversheet.
Submit a reconsideration to Noridian.
Were you revoked for only the following:
- Non-compliance
- On-site review
- Grounds related to provider and supplier screening requirements
- Failure to Report
Submit a reconsideration to Noridian.
Submit your appeal to CMS using the CMS CAP Reconsideration Coversheet.
