A redetermination is an examination of a claim by the fiscal intermediary (FI), carrier, or Medicare Administrative Contractor (MAC) personnel who are different from the personnel who made the initial claim determination. The appellant (the individual filing the appeal) has 120 days from the date of receipt of the initial claim determination to file an appeal. A redetermination must be requested in writing. A minimum monetary threshold is not required to request a redetermination.

Requesting a Redetermination in Writing

A request for a redetermination must be filed either on Form CMS-20027 or in writing. To link to this form, scroll down to "Related Links Inside CMS." A written request not made on Form CMS-20027 must include the following information:

• Beneficiary name

• Medicare Health Insurance Claim (HIC) number

• Specific service and/or item(s) for which a redetermination is being requested

• Specific date(s) of service

• Signature of the party or the authorized or appointed representative of the party

The appellant should attach any supporting documentation to their redetermination request. The FI, carrier, or MAC will generally issue a decision (either in a letter, a revised remittance advice, or a Medicare Summary Notice) within 60 days of receipt of the redetermination request.

Note: FIs, carriers, and MACs can no longer correct minor errors and omissions on claims through the appeals process. For information on how to correct minor errors and omissions, please refer to the Medicare Learning Network (MLN) Matters article in the "Related Links Inside CMS" section below.