When to use Medicare redetermination form

When to send the Redetermination reopen request form?

You must file a request within 120 days from the initial claim determination date to meet the timeliness filing requirement.

Redetermination requests that are not filed timely cannot be considered unless documentation is submitted to explain why the appeal was filed late and that documentation meets the requirement to show good cause for late filing.

Before requesting a redetermination
Check your submission information for accuracy and then prepare your documentation. Keep in mind when selecting the supporting documentation for your request that
= All policies and procedures applicable to the claim will be considered
= Attach all documentation to support the complete questioned service and all services on your claim

For example, a global procedure request should include documentation to support all services provided during the global period in addition to the other services listed on the claim. If you only submit the documentation for one service, you might not obtain your desired results.

Note: Claims rejected as unprocessable (billing errors, indicated with Remark Code MA130) have no appeal rights and should not be submitted as redetermination requests. The only way these can be considered is for the claim to be corrected and resubmitted.

Appeals for multiple claims involving the same issue 

If multiple claims involve the same issue, it is not necessary to submit each appeal separately. A single appeal request can be filed with all claims included. All appeal requests must be submitted in writing. The following items must be clearly identified in each claim of a multiple-claim appeal request:
= Beneficiary name
= Medicare Health Insurance Claim (HIC) Number
= Specific service or item for which the redetermination is being requested (copies of the Remittance Advice or a spreadsheet is acceptable)
= Specific dates of service