March 9, 2010
Submitting Complete Redetermination Requests
When submitting a redetermination request, it is important to include all information relevant to the claim you are appealing. All redetermination requests must contain the following information:
- The printed name (including the last name) and signature of the person filing the request
- The beneficiary's name
- The Medicare health insurance claim number (HICN) of the beneficiary
- The specific service(s) and/or item(s) for which the redetermination is being requested; and
- The specific date(s) of service
It is important that any documentation or remittance advice submitted with the redetermination request match the information listed on the request. In order to perform a complete and accurate review of your case, we must be confident that we are addressing the issues you intended to submit. Therefore when there are attachments that contain information that do not match the information on the form, the request will either be dismissed or returned for clarification.
Common examples of conflicting attachment information:
- The date of service listed on the form is January 10, 2010 for a wheelchair and the remittance advice and/or other information is for a different date of service or item.
- A date of service and a claim control number (CCN) are provided on the request form, but the CCN does not match what we have on file for that date of service. In this case, the redetermination will be conducted based on the date of service only.
Incomplete requests will be dismissed with an explanation of the missing information. You will be instructed to resubmit the request with all of the missing information. Incomplete requests that are resubmitted for appeal must be submitted within the 120 day timely filing limit. Incomplete requests that are resubmitted past the 120 day timely filing limit will be dismissed.
For more information, please visit our Appeals page.
