Has anyone obtained a letter from Medicare that says Medicare will not reimburse a provider or providers because of licensure?

Kim Ross 6 years ago in Billing/Electronic Modules updated by Mark Cornell 4 years ago 7

We have a case where Americas PPO (Mayo Health Solutions) will not pay our claims unless we either send a Medicare EOB or a letter from Medicare to substantiate that the services is not reimbursed by Medicare. Because these types of claims don't get processed by Medicare b/c the provider is not in network, we don't get an EOB. How are we able to get a Medicare letter documenting provider ineligibility for Medicare reimbursement?  

Thanks so much!


I got a reply back stating they don't do those letters. I have to call, but it takes forever to get through.

Were you ever able to get a "Medicare letter" then?  

Not yet. But, hoping Sheryl's contact information for them below will help. I maybe went to broad on my request. Thank you!

The most recent one I have is from 2015, so I imagine the addresses and contacts have changed.  The request was sent to Irene C. Michel, Medicare Provider Enrollment, 8120 Penn Avenue South, Suite 200, Bloomington, MN  55431-1394, and she was the one who wrote the letter back.  

It looks now like NGS is handling the MN-WI-IL region.  I have logged a "Live Person" number there:  877-908-8476.  Perhaps this will help...  Good luck!

I spoke with a Medicare rep at the 877-908-8476. She said they have not provided those letters since 2013. She instead referred me to the cms.gov / manuals / internet-only manuals to the link "medicare program integrity manual". You can find chapter 15.4.8, Suppliers Not Eligible to Participate. She suggested I excerpt and reference that for the payer who insists on a Medicare letter. I did. I will know in 1 - 2 weeks whether they are able to process our claims...


Good luck, Kim!  Glad you were able to speak to someone.  That is really missing with a lot of carriers.

After hours of frustration, here it the form. clinicians can complete, agencies can not.

Medicare Opt-Out From