Appeal Rights and Disaffirmed Revalidations and Reactivations

The NSC is tasked with ensuring entities requesting billing privileges and those already enrolled meet the standards set forth in C.F.R. 42 424.57.

The appeal rights established in C.F.R. 42 405.874 exist for suppliers whose request for billing privileges were denied or for existing suppliers whose privileges were revoked.

When a supplier revalidates or submits a reactivation, the supplier is neither requesting billing privileges nor appealing the decision to revoke those privileges. Therefore, no appeal rights exist for disallowed revalidations or reactivations.

Suppliers whose revalidations or reactivations could not be processed or were found not to meet the standards are required to begin the process again. This entails submitting a CMS 855S completed in its entirety along with all required attachments.

Last Updated: 11/09/2006