Get CMS Medicare DME Redetermination Request Form 2020-2024

There are 5 levels of the appeals process: Redetermination. Reconsideration. Administrative Law Judge (ALJ) Departmental Appeals Board (DAB) Review. Federal Court (Judicial) Review.

To appoint a representative, you or your representative should complete the form entitled: Appointment of Representative - CMS-1696.

The government may decide to reopen the case to apply those new facts to the case and a different decision can be rendered. In a motion to reconsider, you are asking the government to fix an error or to do a correct analysis of the case.

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.

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).

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.

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.

Many CMS program related forms are available in Portable Document Format (pdf). Hard copy forms may be available from Intermediaries, Carriers, State Agencies, local Social Security Offices or End Stage Renal Disease Networks that service your State.