CMS Medicare Advantage
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
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Medicare Advantage Organizations (HMO, PPO, RPPO and PFFS)
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1876 Cost Plans
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Medi-Medi Plans
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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