Original Medicare appeals - Level 1: Redetermination by the company that handles claims for Medicare

If you want to file an appeal, start by looking at your "Medicare Summary Notice" (MSN).  It shows all your services and supplies that providers and suppliers billed to Medicare during a 3-month period, what Medicare paid, and what you may owe the provider. The MSN also shows if Medicare has fully or partially denied your medical claim (this is the initial determination, which is made by the company that handles bills for Medicare). 

Read the MSN carefully. If you disagree with a Medicare coverage or payment decision, you can appeal the decision. The MSN contains information about your appeal rights.

You'll get a MSN in the mail every 3 months, and you must file your appeal within 120 days of the date you get the MSN. You can also track your Medicare claims or view electronic MSNs by visit MyMedicare.gov. Claims will generally be available within 24 hours after processing.

There are 3 ways to file an appeal:

  1. Fill out a "Redetermination Request Form" and send it to the Medicare contractor at the address listed on the MSN.
  2. Follow the instructions on the back of the MSN. You must send your request for redetermination to the company that handles bills for Medicare (their address is listed in the Appeals Information section of the MSN.)
    • Circle the item(s) and/or services you disagree with on the MSN.
    • Explain in writing why you disagree with the decision or write it on a separate piece of paper and attach it to the MSN.
    • Include your name, address, phone number, and Medicare number on the MSN and sign it.
    • Include any other information you have about your appeal with the MSN. Ask your doctor, health care provider, or supplier for any information that may help your case.
  3. Send a letter to the company that handles bills for Medicare (their address is listed in the Appeals Information section of the MSN.) Your letter must include
    • Your name and Medicare number.
    • The specific item(s) and/or service(s) for which you're requesting a redetermination and the specific date(s) of service.
    • An explanation of why you don't agree with the initial determination.
    • Your signature, or the name and signature of your representative.
Note
  • Write your Medicare number on all documents you submit with your appeal request.
  • Keep a copy of everything you send to Medicare as part of your appeal.

You can submit additional information after the redetermination request has been filed, but it may take longer for the QIC to make a decision. If you submit additional evidence after filing the request for redetermination, the contractor’s 60-day decision making time frame is automatically extended for up to 14 calendar days.

You'll generally get a decision from the Medicare contractor (either in a letter or an MSN) called a "Medicare Redetermination Notice" within 60 days after they get your request.

If you disagree with this decision, you have 180 days after you get the notice to request a reconsideration by a Qualified Independent Contractor (QIC).