Beneficiaries and providers dissatisfied with National Government Services’ claim payment determination may use the appeals process to resolve any disagreement. The Part A Appeals Department is responsible for processing Part A and Part B redeterminations, forwarding and effectuating reconsiderations, and effectuating Administrative Law Judge (ALJ) and Medicare Appeals Council (MAC) hearings accurately and on time.
The Five Levels of Appeal
Clerical Error/Omission Request Process
Documentation Requirements by Type of Service
Comprehensive lists of documentation needed for the appeal types of service and documentation requirements
What Types of Services Can Be Appealed
Information on beneficiary and provider appeal rights
Appointing a Representative