As part of its mission in preventing fraud, waste, and abuse, CMS takes several administrative actions concerning provider’s and supplier’s Medicare enrollments. To promote transparency and fairness in civil administrative enforcement and adjudication, select administrative actions implemented by CMS afford certain rights to providers and suppliers. These rights may include the submission of a rebuttal, a Corrective Action Plan (CAP), and/or a request for reconsideration. CMS must then review these submissions and render a written decision informing the provider or supplier of its decision concerning the administrative action.
Please note that any correspondence sent outside of the PEARC contact information listed on this page cannot be processed/answered. We kindly request that all Medicare provider enrollment communication be directed to the contact information provided below. This will ensure that your submission/inquiry is received timely and facilitates effective communication.
Find answers to commonly asked questions about Medicare Provider Enrollment reconsiderations, CAPS and Rebuttals.
Corrective Action Plans (CAP), reconsideration requests, and rebuttals for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) suppliers can be sent by email, fax, or hard copy mail.
Email: PEARC@c-hit.com
Fax: 866-410-7404
Mailing Address:
CMS Provider Enrollment Appeals & Rebuttals
P.O. BOX 45266
Jacksonville, FL 32232
Currently, submission status is not available prior to a rendered decision.
This office does not discuss the subject-matter of any, CAP, reconsideration request, and/or rebuttal, outside of the formal appeals process as outlined in 42 C.F.R. §§ 424 and 498. Any subject-matter appeals information must be provided in writing as a part of an CAP, reconsideration request, and/or rebuttal submission. Our agents can only confirm if your submission has been received and answer any procedural questions regarding the CAP, reconsideration, and/or rebuttal process.
You may request the documents you seek through submission of a FOIA request. More information may be found here.
Please be advised that if you are unsatisfied with a reconsideration decision, you may request a review by an Administrative Law Judge (ALJ). The information regarding the submission of an appeal to an Administrative Law Judge is included on your reconsideration decision letter. (Note: ALJ review is only afforded to those who have requested reconsideration. Further appeal rights are not granted to those who only submit a CAP or rebuttal.)
Processing of submissions are completed in the order in which they are received. This ensures fairness for other provider/suppliers patiently waiting for their decision.
Yes. You may submit additional documentation at any time before a decision is rendered. However, based on the timing and volume of the supplement, the issuance date of your decision may be delayed beyond the original processing period.
You may only submit a Corrective Action Plan (CAP) in response to the denial of an enrollment application under 42 C.F.R. § 424.530(a)(1) and/or in response to the revocation of an enrollment under 42 C.F.R. § 424.535(a)(1). The CAP must be received in writing within 35 calendar days of the date of the initial determination, denial, or revocation letter. You may request reconsideration for Medicare enrollment denial or revocation under any regulatory basis. A reconsideration request must be received in writing within 65 calendar days of the initial determination, denial, or revocation letter. The timeframes to submit a CAP and a reconsideration request run at the same time. You may submit a rebuttal in response to a Medicare enrollment deactivation. Rebuttals must be submitted within 15 calendar days of the date of the deactivation letter.
We are unable to provide advice on the supporting documentation to provide with your case.
With regard to a CAP, the CAP is an opportunity to demonstrate that you have corrected the deficiencies identified in the denial or revocation letter and establish your eligibility to enroll in the Medicare program. You may provide evidence to demonstrate that you are in compliance with Medicare requirements.
You may submit additional information with the reconsideration request that may have a bearing on the decision. However, if you have additional information that you would like a Hearing Officer to consider during the reconsideration review or, if necessary, an Administrative Law Judge (ALJ) to consider during a hearing, you must submit that information with your request for reconsideration. This is your only opportunity to submit information during the administrative appeals process unless an ALJ allows additional information to be submitted.
With regard to a rebuttal, you may submit all documentation you want to be considered in the review of the deactivation.
No.
Generally, with regard to an enrollment denial, under 42 C.F.R. § 424.505, to receive payment for covered Medicare items or services, a provider or supplier must be enrolled in the Medicare program. Under 42 C.F.R. § 424.545(a)(2), payment is not made during the appeals process. If the provider or supplier is successful in overturning a revocation, unpaid claims for services furnished during the overturned period may be resubmitted. Under 42 C.F.R. § 424.540(e), a provider or supplier may not receive payment for services or items furnished while deactivated.
Decisions will be sent via certified hard copy mail. Decisions may also be sent via email and/or fax if an email address or fax number was provided with your submission.
Decisions will be sent from the following:
Email: PEARC@c-hit.com
Fax: 866-410-7404
Mailing Address:
CMS Provider Enrollment Appeals & Rebuttals
P.O. BOX 45266
Jacksonville, FL 32232
To ensure accuracy, please provide the case # and address you believe is on file and we will verify it for you.
If the address provided is not on file and you would like us to utilize this address for the appeals process please submit an updated enrollment application to the applicable National Provider Enrollment contractor to update your enrollment information. We will also note your new address for purposes of sending the appeals decision.