A provider or beneficiary may appeal an initial claim determination when Medicare's decision is to deny or reduce payment based on §1862(a)(1), §1834(a)(17)(B), §1834(j)(1), or §1834(a)(15). There are five levels in the Medicare appeals process.
For more information about each appeal level, including requirements and timeframes, refer to the Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network (MLN) brochure titled "The Medicare Appeals Process".
Level 1: Redetermination
- Medicare Redetermination Request Form
Redetermination requests should be mailed to the following address:
J15 — HHH Correspondence
CGS Administrators, LLC
PO Box 20014
Nashville, TN 37202
Level 2: Reconsideration
Level 3: Administrative Law Judge Hearing
Level 4: Appeals Council Review
Level 5: Judicial Review
- CGS Appeals Frequently Asked Questions
- Original Medicare (Fee-for-service) Appeals
- Medicare Claims Processing Manual (Pub. 100-04, Ch. 29)