Rebuttal Process: Provider Enrollment

1. Deactivation because the provider or supplier did not submit Medicare claims for 12 consecutive calendar months.
2. Deactivation because the provider or supplier did not report a change to the information supplied on the enrollment application within the applicable timeframe. Changes that must be reported within 90 calendar days include, but are not limited to, a change in practice location, a change of any managing employee or a change in billing services. Changes that must be reported within 30 calendar days include a change in ownership or control.
3. Deactivation because the provider not furnish complete and accurate information and all supporting documentation within 90 calendar days of receipt of notification from CMS to submit an enrollment application, or resubmit and certify to the accuracy of its enrollment information.

Must be submitted within 20 calendar days from date of the deactivation notice. Any rebuttal submitted after the 20 days will be dismissed. 

The requests may be emailed, faxed or mailed to Palmetto GBA.

1. Must specify the facts or issues with which the provider or supplier disagrees and the reasons for the disagreement.
2. Should include all documentation and information the provider or supplier would like to be considered in reviewing the deactivation.
3. Must be submitted in the form of a letter that is signed and dated by the individual provider, supplier, authorized or delegated official or legal representative as defined in 42 CFR § 498.10.
   1. If the legal representative is an attorney, the attorney must include a statement that he or she has the authority to represent the provider or supplier.
   2. If the legal representative is not an attorney, the provider or supplier must file written notice of the appointment of a representative with the MAC. This notice of appointment must be signed and dated by the individual provider or supplier, the authorized or delegated official, or a legal representative.