CMS Pub. 100-04, ch. 32, § 350.12

When a MAC receives a beneficiary appeal of a claim submitted by the beneficiary for services provided by a non-participating provider, the MAC will process the appeal in accordance with the guidelines in Pub. 100-04 chapter 29.

When a MAC receives an appeal from a non-participating provider of a claim that was submitted by, or on behalf of, a

beneficiary, the MAC shall dismiss the appeal request as the non-participating provider is not a proper party. The MAC

shall send a copy of the dismissal to the beneficiary. A non-participating provider does not have standing to file an

appeal for the individual claims for payment it submits on behalf of a beneficiary, or for claims the beneficiary submits

for services it has furnished. See, 42 CFR 405.906(a)(3) and 405.902 (for the definition of provider); Pub. 100-04,

chapter 29, §210 and the glossary in Pub. 100-04, chapter 29, §110 (for the definition of provider). Only a beneficiary

(or the beneficiary’s authorized representative, or an appointed representative on behalf of the beneficiary) can appeal

claim determinations for services furnished by a non-participating provider.

NOTE: Non-participating providers have appeal rights under the provider and supplier enrollment appeals process in 42

CFR Part 498 for MAC determinations related to the non-participating provider’s election to file claims (see §350.10).

NOTE: The RRB conducts Part B redeterminations under the Railroad Retirement Act for services rendered in Canada.