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Itten Order ABN Medical Documentation Reasons/Rationale Fax Numbers Noridian Healthcare Solutions - JA CGS Administrators, LLC - JB CGS Administrators, LLC - JC Noridian Healthcare Solutions - JD 1-701-277-2425 1-615-660-5976 1-615-782-4630 1-701-277-7886 Page 1 of 1 June 21, 2017. 2017 Copyright.

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Any party to the initial claim determination that is dissatisfied with the decision may request a redetermination. A redetermination is a review of the claim by Medicare Administrative Contractor (MAC) personnel not involved in the initial claim determination.

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).

Yes, the claims reopening process is specifically for simple corrections or omissions that do not require additional documentation. More complicated issues must be submitted in writing. The redetermination form is used for the first level appeal and the reconsideration form for the second level appeal.

Fill out a "Redetermination Request Form [PDF, 100 KB]" and send it to the company that handles claims for Medicare. Their address is listed in the "Appeals Information" section of the MSN. Or, send a written request to company that handles claims for Medicare to the address on the MSN.

Fax request to 1-888-541-3829. Do not mail or fax a Redetermination request multiple times. Multiple requests can be mailed in one envelope: Must include Redetermination form for each request.

What's it used for? Requesting an appeal (redetermination) if you disagree with Medicare's coverage or payment decision.

Medicare Appeal Letter Template Dear Sir/Madam, I am writing to appeal the recent decision made by Medicare regarding my [specific service or item] claim, which was denied on [Date of Medicare Decision]. I appreciate the prompt response I received, but I believe that there has been an error in the decision.

A redetermination is performed by the same contractor that processed your Medicare claim. However, the individual that performs the appeal is not the same individual that processed your claim. The appeal is a new and independent review of your claim.

The first level of an appeal for Original Medicare is called a redetermination. A redetermination is performed by the same contractor that processed your Medicare claim. However, the individual that performs the appeal is not the same individual that processed your claim.

If a claim is initially denied, there is action the facility can take. The next step is referred to as “redetermination.” If the claim is again denied after the redetermination, the following step is “reconsideration.” The following information provided by CMS explains each of these steps.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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 workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
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