Appeals of Claims Involving Excluded Providers, Physicians, or Other

280.7 - Appeals of Claims Involving Excluded Providers, Physicians, or Other Suppliers (Rev. 3549, Issued: 06-24-16, Effective: 07-26-16, Implementation: 07-26-16) The appeals process remains in effect for all claims with service dates prior to the effective date of exclusion. An excluded provider, physician, or supplier, or the beneficiary may appeal such claims. In addition, if the billing privileges of a provider, physician, or supplier are revoked retroactively, and the contractor reopens previously paid claims to assess an overpayment against the excluded party, the excluded party (or the beneficiary) may appeal the revised initial determination and overpayment under the claims appeal process (42 CFR part 405 subpart I). NOTE: A provider or supplier's appeal of a revocation or denial of billing privileges is processed in accordance with the procedures set forth in 42 CFR part 405 subpart H and 42 CFR part 498 (see also, IOM 100-08, Chapter 15, §15.25). The contractor is bound by the terms of the revocation action unless billing privileges are reinstated under the enrollment appeals process.