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