US · guidance
CMS Pub. 100-04, ch. 17, § 101.3
Dispute Resolution Services for Beneficiaries
The approved CAP vendor is not permitted to bill the beneficiary for any coinsurance or
deductible until the approved CAP vendor’s drug product claim has been paid by the
designated A/B MAC (B). If the approved CAP vendor does bill the beneficiary before
payment on the drug claim has been received, or if the approved CAP vendor bills the
beneficiary too much after the drug product claim has been paid, then the beneficiary
may use the approved CAP vendor’s grievance process to challenge the inappropriate
billing. If the approved CAP vendor’s grievance process does not yield satisfactory
results for the beneficiary, then the beneficiary may ask the CAP designated A/B MAC
(B) to counsel the approved CAP vendor on its contractual CAP obligations.
History
(Rev. 1076, Issued: 10-13-2006; Effective: 07-01-06; Implementation: 11-13-06)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
e7f93bf05695c3c11fb57f77b0ed31857838b45e95ddafdd0b0e3fd5be20d4fd
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