As of June 18, 2026, Rula no longer credentials providers with an active Medicare opt-out. If you have an active opt-out, new patient matching has been paused for you. This guide explains how to restore your eligibility.
This guide is for any Rula provider who filed a Medicare opt-out affidavit in the past and now wants to become eligible for the Medicare program, whether to bill Medicare directly or to see Medicare Advantage patients again under standard enrollment.
If you have never opted out of Medicare, this guide does not apply to you.
Two ways back to Medicare eligibility
Your path back depends on timing. Confirm which situation applies to you before taking any action.
Path A: Early termination (first opt-out only, within 90 days)
If this is the first time you have ever opted out, and you are still within 90 days of your original opt-out's effective date, you can terminate early.
Path B: Standard cancellation (any point in your two-year cycle)
If you are past the 90-day window, or this is not your first opt-out, you cancel your opt-out by written notice. Your written cancellation must reach every MAC where you filed an affidavit at least 30 calendar days before your current opt-out period expires. If you miss that window, your opt-out automatically renews for another two-year cycle.
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Your opt-out status does not change early under Path B. This is a non-renewal notice, not an early exit. Filing the cancellation letter does not end your opt-out the day the MAC receives it. You remain opted out for the entire remainder of your current two-year period. The notice only stops the cycle from automatically renewing. Once your current opt-out period naturally expires, you are once again eligible for Medicare participation without having to do anything further. Example: if your opt-out is set to expire October 1, and you mail your cancellation notice in June, you are still opted out from June through September 30. Your status changes on October 1, not before. Only early termination (Path A) ends opt-out status ahead of schedule, and that option is limited to a provider's first-ever opt-out, within 90 days of its effective date. |
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Cancellation does not equal enrollment. Once your opt-out period expires under Path B, you are not automatically enrolled. If you want to see Medicare Fee for Service patients with Rula, you still need to submit a full Medicare enrollment application through PECOS. |
Step-by-step process
- Confirm your opt-out details. If possible, locate your original opt-out affidavit and note every MAC you filed it with, and your opt-out effective and expiration dates.
- Identify your MAC. Use the mailing address directory later in this guide, or confirm directly on the CMS "Who are the MACs" page.
- Draft your written cancellation letter. Include your name, NPI, tax ID, the date of your original opt-out affidavit, and a clear statement that you are canceling your opt-out and do not want it to renew for another two-year period. Example letter templates below for your convenience.
- Sign and date the letter.
- Mail the letter to every MAC where the original affidavit was filed, using the mailing address directory later in this guide. Use certified mail with return receipt requested every time. This is not optional: it is your only reliable proof of when the MAC received your notice.
- Confirm timing. Your letter must arrive at least 30 days before your opt-out expiration date. Mail early. Remember that under Path B your opt-out remains active through the expiration date itself; the notice only prevents renewal.
- If you were never previously enrolled, follow up with the MAC. There is no standardized automatic confirmation notice for a cancellation, unlike the original opt-out affidavit. Call the MAC's provider enrollment line roughly 2 to 3 weeks after mailing to confirm receipt and processing status.
- You can also check PECOS. Once processed, your enrollment status will update in PECOS. This is your practical proof that the opt-out was canceled and enrollment reinstated.
- Notify the Rula credentialing team (credentialingteam@rula.com) once your MAC confirms the change, so your payer enrollment and roster records can be updated.
Proof of receipt and processing: what to expect
Providers often ask for a confirmation notice similar to the one MACs issue when you first opt out. That is not guaranteed on the way back in. Plan around these realities:
- Most MACs do not issue an automatic written confirmation for a cancellation the way they do for an opt-out affidavit.
- Your strongest proof of delivery is your own certified mail receipt or portal submission confirmation, not something the MAC sends you.
- Some MACs will issue a written determination letter on request, but this is not consistent across all 12 jurisdictions.
- The most reliable confirmation that your status has actually changed is your enrollment record in PECOS.
- If you call the MAC for a status check, get a representative name and a call reference number every time.
Documentation checklist
Keep every item below on file for your records.
| ☐ | Copy of the signed, dated cancellation letter sent to each MAC |
| ☐ | Certified mail receipt or courier tracking number, and the delivery confirmation once available |
| ☐ | Copy of the original opt-out affidavit, for reference to the MAC and jurisdiction on file |
| ☐ | Any written response or determination letter received from the MAC |
| ☐ | Notes from any phone call with the MAC: date, representative name, and reference or call number |
Mailing address directory for cancellation notices
Find your jurisdiction below to mail your cancellation notice. Click a contractor name to go directly to that MAC's opt-out information page. These are the Part B provider enrollment addresses, which is where opt-out affidavits and cancellation notices are filed.
| Jurisdiction | Contractor (linked to opt-out info) | Phone | Mailing address (opt-out / Part B enrollment correspondence) | States |
|---|---|---|---|---|
| JJ | Palmetto GBA | 877-567-7271 | Palmetto GBA, Part B Provider Enrollment (AG-310), P.O. Box 100306, Columbia, SC 29202-3306 | AL, GA, TN |
| JM | Palmetto GBA | 855-696-0705 | Palmetto GBA, Part B Provider Enrollment (AG-301), P.O. Box 100190, Columbia, SC 29202-3190 | NC, SC, VA, WV |
| JE | Noridian Healthcare Solutions | 855-609-9960 | Noridian JE Part B, PO Box 6774, Fargo, ND 58108-6774 (same address for all JE states/territories) | CA, HI, NV, AS, GU, MP |
| JF | Noridian Healthcare Solutions | 877-908-8431 | Noridian JF Part B, PO Box 6700, Fargo, ND 58108-6700 (same address for all JF states) | AK, AZ, ID, MT, ND, OR, SD, UT, WA, WY |
| JH | Novitas Solutions | 855-252-8782, Option 4 | Novitas Solutions, Provider Enrollment Services, PO Box 3157, Mechanicsburg, PA 17055 (same PO Box as JL for opt-out affidavits) | AR, CO, LA, MS, NM, OK, TX |
| JL | Novitas Solutions | 877-235-8073, Option 4 | Novitas Solutions, Provider Enrollment Services, PO Box 3157, Mechanicsburg, PA 17055 (same PO Box as JH for opt-out affidavits) | DE, DC, MD, NJ, PA, VA (Arlington/Fairfax/Alexandria only) |
| JK | National Government Services | 888-379-3807 | National Government Services, P.O. Box 6178, Indianapolis, IN 46206-6178 | CT, ME, MA, NH, NY, RI, VT |
| J6 | National Government Services | 877-908-8476 | National Government Services, P.O. Box 6475, Indianapolis, IN 46206-6475 | IL, MN, WI |
| J5 | WPS Government Health Administrators | 866-518-3285 | WPS Government Health Administrators, Medicare Provider Enrollment, PO Box 8248, Madison, WI 53708-8248 (same PO Box as J8) | IA, KS, MO, NE |
| J8 | WPS Government Health Administrators | 866-234-7331 | WPS Government Health Administrators, Medicare Provider Enrollment, PO Box 8248, Madison, WI 53708-8248 (same PO Box as J5) | IN, MI |
| J15 | CGS Administrators | 866-276-9558 | J15 Part B Provider Enrollment, CGS Administrators LLC, PO Box 20017, Nashville, TN 37202 | KY, OH |
| JN | First Coast Service Options | 888-845-8614 | First Coast Service Options, Provider Enrollment Services, PO Box 3409, Mechanicsburg, PA 17055-1849 | FL, PR, USVI |
Source: CMS Medicare Fee-for-Service Provider Enrollment Contact List. Addresses, phone numbers, and linked pages can change between updates. Confirm the current address directly with the MAC, by phone or on its website, before mailing anything time-sensitive.
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Always use certified mail with return receipt requested. Send every cancellation notice by certified mail with return receipt requested, regardless of which MAC you are mailing to. Your certified mail receipt and the signed return receipt are your primary proof of when the MAC got your letter. Keep both permanently with your credentialing file. If a MAC offers a secure electronic portal as an alternative, you may use it, but still retain the system-generated submission confirmation as your proof of timing. |
Letter Templates
Copy the template that matches your situation into a word processor or email, fill in every bracketed item, and mail it using the directory above. Delete the bracketed instructions once each field is completed.
Template 1: Standard cancellation (Path B)
Use this if you are canceling your opt-out at any point in your two-year cycle, not within the first 90 days of your first-ever opt-out.
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[Provider Full Name] [Practice Name, if applicable] [Mailing Address] [City, State, ZIP] [NPI: XXXXXXXXXX] [PTAN: XXXXXXX, if previously assigned]
[Date]
[MAC Contractor Name] [MAC Mailing Address, from the directory above]
RE: Cancellation of Medicare Opt-Out Status Provider Name: [Full Name] NPI: [XXXXXXXXXX] Original Opt-Out Affidavit Date: [Month Day, Year] Current Opt-Out Period Expiration Date: [Month Day, Year]
To Whom It May Concern:
I am writing to notify [MAC Name] that I do not wish to extend my Medicare opt-out status for a subsequent two-year period. I originally opted out of Medicare by filing an opt-out affidavit dated [Month Day, Year]. My current opt-out period is set to expire on [Month Day, Year].
By this letter, I am canceling my opt-out status effective at the end of my current opt-out period. I understand that my opt-out status remains in effect through [Month Day, Year], and that I will return to Medicare at the end of that period.
If I was previously enrolled in Medicare before opting out, I request that my prior enrollment be reactivated at that time. If I was not previously enrolled, I will separately submit a Medicare enrollment application through PECOS.
Please confirm receipt of this notice and advise if any additional information is required. I can be reached at [phone number] or [email address].
Sincerely, [Signature] [Printed Name] [Date] |
Template 2: Early termination (Path A)
Use this only if this is your first-ever opt-out and you are still within 90 days of its effective date.
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[Provider Full Name] [Practice Name, if applicable] [Mailing Address] [City, State, ZIP] [NPI: XXXXXXXXXX] [PTAN: XXXXXXX, if previously assigned]
[Date]
[MAC Contractor Name] [MAC Mailing Address, from the directory above]
RE: Early Termination of Medicare Opt-Out Status Provider Name: [Full Name] NPI: [XXXXXXXXXX] Opt-Out Affidavit Effective Date: [Month Day, Year]
To Whom It May Concern:
I am writing to request early termination of my Medicare opt-out status. This is my first opt-out from the Medicare program, and my opt-out affidavit became effective on [Month Day, Year], which is within 90 days of the date of this letter.
I understand that early termination will reinstate my Medicare enrollment as if I had never opted out, retroactive to [Month Day, Year]. I confirm that I have refunded, or will refund, any amounts collected under private contracts during the opt-out period that exceeded what Medicare would have approved for the same services.
Please confirm receipt of this request and advise of any additional steps needed to complete reinstatement. I can be reached at [phone number] or [email address].
Sincerely,
[Signature] [Printed Name] [Date] |
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Before sending either letter Confirm the correct mailing address from the directory above, send by certified mail with return receipt requested, and keep a copy of the signed letter plus the mailing receipt in the provider's file. If the original opt-out affidavit was filed with more than one MAC, this letter needs to be sent to each MAC separately. |
Questions or issues
Contact the Rula Credentialing and Payer Enrollment team (Credentialingteam@rula.com) before sending anything to a MAC if you are unsure which path applies to you, or if you need help confirming your MAC. We can also help track your cancellation once it is submitted and update your Rula enrollment records once your MAC confirms the change.
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