US · guidance
CMS Pub. 100-04, ch. 29, § 280.7
Appeals of Claims Involving Excluded Providers, Physicians, or Other
Suppliers
(Rev. 3549, Issued: 06-24-16, Effective: 07-26-16, Implementation: 07-26-16)
The appeals process remains in effect for all claims with service dates prior to the effective date of
exclusion. An excluded provider, physician, or supplier, or the beneficiary may appeal such claims. In
addition, if the billing privileges of a provider, physician, or supplier are revoked retroactively, and the
contractor reopens previously paid claims to assess an overpayment against the excluded party, the excluded
party (or the beneficiary) may appeal the revised initial determination and overpayment under the claims
appeal process (42 CFR part 405 subpart I).
NOTE: A provider or supplier's appeal of a revocation or denial of billing privileges is processed in
accordance with the procedures set forth in 42 CFR part 405 subpart H and 42 CFR part 498 (see also, IOM
100-08, Chapter 15, §15.25). The contractor is bound by the terms of the revocation action unless billing
privileges are reinstated under the enrollment appeals process.
History
(Rev. 3549, Issued: 06-24-16, Effective: 07-26-16, Implementation: 07-26-16)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
c98d5a8ba81875417ab7f363e57fdf3594bae24c9d0633563e9db91e16ef9b60
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