Appeals Level 1: Company handling Medicare claims redetermination

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 log into your secure Medicare account to track your Medicare claims or sign up for electronic MSNs to view or download them anytime. 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 [PDF, 100 KB]" and send it to the Medicare contractor at the address listed on the MSN.
  2. Follow the instructions for sending an appeal. You must send your request for redetermination to the company that handles claims 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, along with your Medicare number, and attach it to the MSN.
    • Include your name, phone number, and Medicare number on the MSN.
    • Include any other information you have about your appeal with the MSN. Ask your doctor, other health care provider, or supplier for any information that may help your case.
  3. Send a written request to the company that handles claims for Medicare (their address is listed in the "Appeals Information" section of the MSN.) Your request 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.
    • If you've appointed a representative, include the name of your representative.

You can submit additional information or evidence after the filing redetermination request, but, it may take longer than 60 days for the Medicare Administrator Contractor (MAC) that processes claims for Medicare to make a decision. If you submit additional information or evidence after filing, the MAC will get an extra 14 calendar days to make a decision for each decision.

You'll generally get a decision from the MAC (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).