US Medicare Provider and Supplier Enrollment (42 CFR Part 424 Subpart P)
Effective dates, retrospective billing, rejection and return of applications, enhanced oversight (424.520 to 424.527) – US Medicare Provider and Supplier Enrollment (42 CFR Part 424 Subpart P)

US Medicare Provider and Supplier Enrollment (42 CFR Part 424 Subpart P) 424.525-526: Respond to contractor development requests within 30 days with the missing information and supporting documentation, submit properly signed, dated, current and complete forms to the right contractor at the right time, and resubmit a new application after a rejection or return (no appeal rights)

A contractor may reject an application where the provider or supplier fails to furnish complete information within 30 calendar days of the request (missing required data, an unsigned or undated application, a copied or stamped signature, a signature more than 120 days old, an unauthorised signatory, a missing certification statement, pencil, unauthorised fax or email submission, an incomplete reassignment package or the wrong form), fails to furnish all supporting documentation within 30 days of submission, or omits the institutional application fee or hardship request; CMS may extend the 30 days where the provider is actively working to resolve issues. A contractor may return an application sent to the wrong contractor, received more than 60 days before the effective date (180 days for CMS-855A applicants, ambulatory surgical centers and portable x-ray suppliers), submitted more than 90 days before a change of ownership, filed during an appeal period or an existing re-enrollment or reapplication bar, not needed for the transaction, submitted more than 7 months before the revalidation due date, with an MDPP coach start date more than 30 days out, withdrawn, an exact duplicate, on an outdated form, or an initial application overtaken by a change of ownership application. Rejections and returns carry no appeal rights; the provider must complete and submit a new application with all supporting documentation.

Maintained by Gerard Blokdyk

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