Asked by: Auxiliadora Klaasen
asked in category: General Last Updated: 2nd May, 2020

What is a redetermination request?

Redetermination. The first level of an appeal, a Redetermination, is a request to review a claim when there is a dissatisfaction with the original determination. A Redetermination is an independent re-examination of an initial claim determination.

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Then, what is redetermination form?

A redetermination is the first level of the appeals process and is an independent re-examination of an initial claim determination. A claim must be appealed within 120 days from the date of receipt of the initial Medicare Summary Notice (MSN), Remittance Advice (RA) or Overpayment Demand Letter.

Subsequently, question is, what is the difference between reconsideration and redetermination? 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).

Herein, how do I fill out a Medicare Redetermination Request Form?

There are 2 ways that a party can request a redetermination:

  1. Fill out the form CMS-20027 (available in “Downloads” below).
  2. 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.

How long do you have to file a Medicare appeal?

120 days

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