CMS Non Par Provider Info

Non-Par Provider Payment Dispute Resolution Process


Effective January 1, 2010, the Centers for Medicare & Medicaid Services(CMS) expanded its current provider payment dispute resolution process (PDR) for disputes between non-contracted and deemed providers and Private Fee for Service Plans (FFS) to include disputes between non-contracted providers and all:

  • Medicare Advantage Organizations (HMO, PPO, RPPO and PFFS)
  • 1876 Cost Plans
  • Medi-Medi Plans
  • Program of All-Inclusive Care for the Elderly (PACE) organizations

Download full details of this process here.


The following sample letters provide details on Hill Physicians' compliance with this program:


CMS PDR Letter - Request for Additional Information

CMS PDR Letter - Adjustment Payment Made

CMS PDR Letter - Upheld

CMS PDR Letter - Late Submission

CMS PDR Letter - Closure for Non-Receipt

Waiver of Liability Statement Form for Non-Par Providers

CMS Waiver of Liability Statement ​

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