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.

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Q0

Are you a Part A Provider?

   
Q1 Q0Y

Are you appealing a deactivation?

   
Q2 Q1Y

Rebuttals can only be submitted for the following deactivation reasons:

  • Non-response to a revalidation request
  • Failure to report a change
  • Non-billing
  • No active practice location for 90 days

Were you deactivated for one of these reason?

   
Q3 Q1N

Are you appealing a rejected or returned application?

   
Q3Y DE

Rejected and returned applications do not have appeal rights.

Q3N DE

Corrective Action Plans (CAPs) must be received within 35 days of the initial determination letter.

Reconsiderations must be received within 65 days of the initial determination letter.

Submit your appeal to CMS using the CMS Appeal Coversheet.

Q4 Q2Y

A rebuttal must be received within 20 days from the date of the deactivation letter.

Is the date on the letter more than 20 calendar days ago?

   
Q2N DE

You do not have rebuttal rights. Contact the Provider Enrollment Contact Center for assistance.

Q4Y DE

Your rebuttal rights have expired. You may reactivate your Medicare enrollment.

Q4N DE

You may submit a rebuttal.

Last Updated Wed, 16 Dec 2020 18:00:26 +0000