Update to Chapter 15 of the Program Integrity Manual - Reconsideration Requests

Change Request (CR) 8222 was recently implemented to make revisions to Chapter 15 of the CMS 'Medicare Program Integrity Manual.' Sections 15.25.1.2 and 15.25.2.2 (Reconsideration Requests) are revised as follows:   The provider, supplier, or Medicare contractor may submit corrected, new, or previously omitted documentation or other facts in support of its reconsideration request of a provider enrollment denial or revocation at any time prior to the Hearing Officer's (HO’s) decision. Upon receipt of the Request for Reconsideration from the National Supplier Clearinghouse, the HO sends a letter of acknowledgement to the appealing supplier.  The HO must determine whether the denial or revocation is warranted based on all of the evidence presented. This includes:

• The initial determination itself,
• The findings on which the initial determination was based,
•  The evidence considered in making the initial determination, and
• Any other written evidence submitted under 42 CFR 498.24(a), taking into account facts relating to the status of the provider or supplier subsequent to the initial determination. 

Contact NSC

Email National Supplier Clearinghouse

Contact a specific NSC department

Telephone: 866-238-9652

IVR: 866-238-9652

Address:

National Supplier Clearinghouse

Palmetto GBA, AG-495

P.O. Box 100142

Columbia, SC 29202-3142

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

National Supplier Clearinghouse MAC

PDAC

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

Anonymous