The first level of appeal is carried out by the affiliated contractor/MAC.
Redeterminations may be submitted electronically or in writing.
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:
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.
Complete the following forms and return to the appropriate National Government Services address.
*You can complete, sign and submit the Part B Redetermination Request Form – Level 1 using the esMD system. Note: This form should be the first page of the redetermination request submission.
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:
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.
To request an appeal in writing, complete the Part A Redetermination Request Form – Level 1 and return to the appropriate National Government Services appeals mailing address.
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:
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.
To request an appeal in writing, complete the Part A Redetermination Request Form – Level 1 and return to the appropriate National Government Services appeals mailing address.
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:
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.
To request an appeal in writing, complete the Part A Redetermination Request Form – Level 1 and return to the appropriate National Government Services appeals mailing address.
National Government Services, Inc.
Appeals Department
P.O. Box 6474 | Indianapolis, IN 46206-6474
National Government Services, Inc.
Appeals Department
P.O. Box 7111 | Indianapolis, IN 46207-7111