Non-Contracted Providers: Denial of Payment for Medicare Programs
You have the right to file a reconsideration request for the denial of payment within 60 calendar days from the date of your denial of payment notice. For your reconsideration request to be processed, you must agree to sign the Waiver of Liability Form (pdf). You should also include any documentation that supports your reason for requesting this reimbursement (i.e., a copy of the original claim, remittance notification showing the denial, pertinent clinical records, and any other supporting documentation to be considered).
Please mail the requested information for your reconsideration request to the following address:
For questions, please call 1-800-995-4543.