All levels of appeals may be submitted by mail. The only types of appeals submitted to National Government Services are reopening and redetermination requests. For information on other types of appeals, check the Levels of Appeals and Time Limits for Filing page.
Download and complete the appeal request form, the CMS-20027 Redetermination Request Form
Print and include with your appeal any medical documentation that supports your request. The medical documentation must be signed and dated by the physician. For help in determining what documentation should be submitted please review the What Documents are Needed? page.
Send your prepared appeals request form and all supporting documentation to the appropriate National Government Services for your jurisdiction.
An appeal of a TPL demand claim may be completed by submitting a hard-copy request. The request for a redetermination can be sent on the Home Health Third Party Liability Demand Bill Redetermination Request Form or in writing.
If you prefer to send a written request in the form of a letter, it should be submitted on company letterhead and include all of the following information:
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