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  • J8a Redetermination Request Form. J8a Redetermination Request Form

Get J8a Redetermination Request Form. J8a Redetermination Request Form

Medicare Part A Request for Redetermination Mail Request to: J8 Indiana: WPS Medicare Part A J8 Indiana Attention: Medicare Appeals PO Box 8602 Madison WI 53708-8602 J8 Michigan: WPS Medicare Part.

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Third Level of Appeal: Decision by Office of Medicare Hearings and Appeals (OMHA) Any party that is dissatisfied with the Qualified Independent Contractor's (QIC's) reconsideration decision may request a hearing before an Administrative Law Judge (ALJ) with the Office of Medicare Hearings and Appeals (OMHA).

Any party to the redetermination that is dissatisfied with the decision may request a reconsideration. A reconsideration is an independent review of the administrative record, including the initial determination and redetermination, by a Qualified Independent Contractor (QIC).

A reconsideration consists of a review of an adverse organization determination, the evidence and findings upon which it was based, and any other evidence the parties submit or the MA organization or CMS obtains.

You must send your request to the QIC that will handle your reconsideration. The QIC's address is listed on the redetermination notice. You can submit additional information or evidence after the reconsideration request has been filed, but it may take longer for the QIC to make a decision.

A redetermination must be requested in writing....Make a written request containing all of the following information: Beneficiary name. Medicare number. Specific service(s) and/or item(s) for which a redetermination is being requested. Specific date(s) of service. Name of the party, or the representative of the party.

The appeals process consists of five levels. The appellant must begin the appeal at the first level after receiving an initial determination. Each level, after the initial determination, has procedural steps the Page 13 appellant must take before appealing to the next level.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232