Request a 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.

Requests for redetermination of nonassigned claims must include a completed Appointment of Representative Form (CMS-1696) or a written statement from the beneficiary giving authorization for you to submit a request on his/her behalf.

Submit Your Redetermination

RECOMMENDED - Use NGSConnex

You can submit your redetermination requests using our free, secure Internet portal, NGSConnex. Use the step-by-step instructions in the NGSConnex User Guide. If supporting documentation needs to be included with the redetermination, follow the instructions 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.

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.

By Mail

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

• Part B Redetermination Request Form – Level 1*
• Appointment of Representative Form (CMS-1696) - if your redetermination request is for nonassigned claims

*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.

J6 Mailing Address:

National Government Services, Inc.
P.O. Box 6475
Indianapolis, IN 46206-6475

JK Mailing Address:

National Government Services, Inc.
P.O. Box 7111
Indianapolis, IN 46207-7111

Please share your thoughts about your experience with our redetermination process.