Non-Par Provider Payment Dispute

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

The following document outlines the resolution process:
Non-Par Provider Payment Dispute Resolution Process

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