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Redetermination

The first level of appeal is carried out by the affiliated contractor/MAC.

  • Time limit to initiate = 120 days from date of receipt of the initial determination notice
  • Time limit to complete the review = 60 days
  • Amount in controversy = no minimum amount

Redeterminations may be submitted electronically or in writing.

Submit Your Redetermination

RECOMMENDED - Use NGSConnex

You can submit your redetermination requests using our free, secure Internet portal, NGSConnex. 

If you are an existing NGSConnex user, you can initiate a redetermination by completing the following steps:

  1. Click the My Claims tab
  2. If there is more than one provider account, click the Select button for that account
  3. Select Claims under the Claim Type drop down and click the Go button
  4. Enter the Beneficiary Medicare Number, Beneficiary Last Name, Beneficiary First Name (at least the first initial), Beneficiary Date of Birth (Format: MMDDYYYY or MM/DD/YYYY)
    • You can narrow your search by entering from service date, to service date, and/or a claim number if you wish
  5. Click the Load Claims button
  6. Locate the claim you wish to initiate a redetermination for and click on the Claim Number
  7. Click the Initiate Redetermination/Reopening button
  8. Complete the redetermination form; all fields with red asterisk are required
  9. Click the OK button
    • If the form continues to display on your screen, scroll to the top of the form to locate your error message, correct the error and click on the OK button again
    • If you see an error message, make sure that all required fields are completed
    • If after clicking on the OK button, the form disappears and the My Redeterminations/Reopenings tab displays, the request was received
  10. If supporting documentation needs to be included with the redetermination, click on the New button under the attachment section to add the documentation
    • Note: There are no file size limitations to the attachments that can be submitted in NGSConnex; the only file types not accepted are: .xml, .log, and .cfg.

Please Note: If there are multiple services on the same claim in question (same ICN), you only need to submit a single redetermination/reopening request. You should not submit multiple redetermination/reopening requests for the same claim.

Log in to NGSConnex

By Mail

Complete the following forms and return to the appropriate National Government Services address.

  • CMS-20027 Medicare Redetermination Request Form*
  • Appointment of Representative Form (CMS-1696) - if your redetermination request is for nonassigned claims

*You can complete, sign and submit the CMS-20027 Medicare Redetermination Request Form using the esMD system. Note: This form should be the first page of the redetermination request submission.

RECOMMENDED - Use NGSConnex

You can submit your redetermination requests using our free, secure internet portal, NGSConnex. 

If you are an existing NGSConnex user, you can initiate a redetermination by completing the following steps:

  1. Click the My Claims tab
  2. If there is more than one provider account, click the Select button for that account
  3. Select Claims under the Claim Type drop down and click the Go button
  4. Enter the Beneficiary Medicare Number, Beneficiary Last Name, Beneficiary First Name (at least the first initial), Beneficiary Date of Birth (Format: MMDDYYYY or MM/DD/YYYY)
    • You can narrow your search by entering from service date, to service date, and/or a claim number if you wish
  5. Click the Load Claims button
  6. Locate the claim you wish to initiate a redetermination for and click on the Claim Number
  7. Click the Initiate Redetermination/Reopening button
  8. Complete the redetermination form; all fields with red asterisk are required
  9. Click the OK button
    • If the form continues to display on your screen, scroll to the top of the form to locate your error message, correct the error and click on the OK button again
    • If you see an error message, make sure that all required fields are completed
    • If after clicking on the OK button, the form disappears and the My Redeterminations/Reopenings tab displays, the request was received
  10. If supporting documentation needs to be included with the redetermination, click on the New button under the attachment section to add the documentation
    • Note: There are no file size limitations to the attachments that can be submitted in NGSConnex; the only file types not accepted are: .xml, .log, and .cfg.

Please Note: If there are multiple services on the same claim in question (same ICN), you only need to submit a single redetermination/reopening request. You should not submit multiple redetermination/reopening requests for the same claim.

Log in to NGSConnex

By Mail

To request an appeal in writing, complete the CMS-20027 Medicare Redetermination Request Form and return to the appropriate mailing address.

RECOMMENDED - Use NGSConnex

You can submit your redetermination requests using our free, secure internet portal, NGSConnex. 

If you are an existing NGSConnex user, you can initiate a redetermination by completing the following steps:

  1. Click the My Claims tab
  2. If there is more than one provider account, click the Select button for that account
  3. Select Claims under the Claim Type drop down and click the Go button
  4. Enter the Beneficiary Medicare Number, Beneficiary Last Name, Beneficiary First Name (at least the first initial), Beneficiary Date of Birth (Format: MMDDYYYY or MM/DD/YYYY)
    • You can narrow your search by entering from service date, to service date, and/or a claim number if you wish
  5. Click the Load Claims button
  6. Locate the claim you wish to initiate a redetermination for and click on the Claim Number
  7. Click the Initiate Redetermination/Reopening button
  8. Complete the redetermination form; all fields with red asterisk are required
  9. Click the OK button
    • If the form continues to display on your screen, scroll to the top of the form to locate your error message, correct the error and click on the OK button again
    • If you see an error message, make sure that all required fields are completed
    • If after clicking on the OK button, the form disappears and the My Redeterminations/Reopenings tab displays, the request was received
  10. If supporting documentation needs to be included with the redetermination, click on the New button under the attachment section to add the documentation
    • Note: There are no file size limitations to the attachments that can be submitted in NGSConnex; the only file types not accepted are: .xml, .log, and .cfg.

Please Note: If there are multiple services on the same claim in question (same ICN), you only need to submit a single redetermination/reopening request. You should not submit multiple redetermination/reopening requests for the same claim.

Log in to NGSConnex

By Mail

To request an appeal in writing, complete the CMS-20027 Medicare Redetermination Request Form and return to the appropriate National Government Services address.

RECOMMENDED - Use NGSConnex

You can submit your redetermination requests using our free, secure internet portal, NGSConnex. 

If you are an existing NGSConnex user, you can initiate a redetermination by completing the following steps:

  1. Click the My Claims tab
  2. If there is more than one provider account, click the Select button for that account
  3. Select Claims under the Claim Type drop down and click the Go button
  4. Enter the Beneficiary Medicare Number, Beneficiary Last Name, Beneficiary First Name (at least the first initial), Beneficiary Date of Birth (Format: MMDDYYYY or MM/DD/YYYY)
    • You can narrow your search by entering from service date, to service date, and/or a claim number if you wish
  5. Click the Load Claims button
  6. Locate the claim you wish to initiate a redetermination for and click on the Claim Number
  7. Click the Initiate Redetermination/Reopening button
  8. Complete the redetermination form; all fields with red asterisk are required
  9. Click the OK button
    • If the form continues to display on your screen, scroll to the top of the form to locate your error message, correct the error and click on the OK button again
    • If you see an error message, make sure that all required fields are completed
    • If after clicking on the OK button, the form disappears and the My Redeterminations/Reopenings tab displays, the request was received
  10. If supporting documentation needs to be included with the redetermination, click on the New button under the attachment section to add the documentation
    • Note: There are no file size limitations to the attachments that can be submitted in NGSConnex; the only file types not accepted are: .xml, .log, and .cfg.

Please Note: If there are multiple services on the same claim in question (same ICN), you only need to submit a single redetermination/reopening request. You should not submit multiple redetermination/reopening requests for the same claim.

Log in to NGSConnex

By Mail

To request an appeal in writing, complete the CMS-20027 Medicare Redetermination Request Form and return to the appropriate National Government Services appeals mailing address.

Log in to NGSConnex

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J6 Mailing Address:

National Government Services, Inc.

Appeals Department

P.O. Box 6474 | Indianapolis, IN 46206-6474

JK Mailing Address:

National Government Services, Inc.

Appeals Department

P.O. Box 7111 | Indianapolis, IN 46207-7111

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