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Appeals

What is an Appeal?

An Appeal is your opportunity to formally question how your claim was processed and/or paid. Use this section to review the Appeals options available to you.

The 5 Levels of the Appeals Process

The Medicare program gives you the right to appeal a claim decision. This section provides detailed information on Redeterminations, Reconsiderations, Administrative Law Judge (ALJ), Departmental Appeals Board (DAB) Reviews and the Federal Court (Judicial) Review.

Appeals Timelines

CMS has established specific timelines for each of the 5 levels of the appeal process. If you are planning to appeal a claim decision, use this section to locate timeliness requirements.

How Do I Appeal An Overpayment?

This section provides important instructions on how to properly appeal an overpayment.

Appeals Forms and Tools

We have created a variety of tools and forms to help you file your appeal in a timely manner. Use this section to locate the various online tools of benefit in your appeals process.

Only Send What is Necessary for a Redetermination Request

The CGS Redetermination department is noticing that there is an increase in the amount of documentation sub mitted with redetermination requests. The first step in responding to a claim denial is to review the reason for the denial. Use the myCGS web Portal to learn why claims deny.

Where Do I Send my Appeal?

Each level of appeal has a specific address and/or fax number. Use this section to locate the address and other relevant contact information for your specific level of appeal.

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