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Submitting Redetermination Requests

This form may be used to request a redetermination for Medicare Part B services. A redetermination is the first level of the Medicare Appeals Process. All requests should be submitted within 120 days of the initial claim determination.

Appellants should attach any supporting documentation to their redetermination request. CGS has 60 days to process an appeal request. Do not submit a duplicate appeal, if a request has been submitted.

Note: To submit a second level appeal request (Reconsideration), click hereExternal website.

Please be advised, CMS has instructed all contractors to no longer correct minor errors and omissions on claims through the appeals process. Please refer to the MLN bookletPDF on the Appeals process for more information.

Redetermination requests can be made, but are not limited to the following situations:

  • If Claim denied for duplicate service, then medical necessity must be established.
    NOTE: Documentation should be included to support each service billed.
  • Ambulance denials.
    NOTE: Run tickets should be included to support each trip.
  • Charges denied as Part A because the patient was seen in the office prior to admission in the hospital.
    NOTE: Documentation should be included to support the office service.
  • Claim denied as not medically necessary and a GA modifier has been added to the claim.
    NOTE: A copy of the Advance Beneficiary Notice should be included with the request.

Providers can utilize the myCGS web portal to submit a Redetermination request form. Click here for more information.

To submit a hardcopy Redetermination request, we also need the following pieces of information:

  • The beneficiary's name
  • The Medicare Beneficiary Identifier (MBI)
  • The DOS and the name of the service or item
  • The name of the person filing the Redetermination request
  • Send Redeterminations to the below address:

    J15 — Part B Correspondence
    CGS Administrators, LLC
    PO Box 20018
    Nashville, TN 37202

  • Medicare Redetermination Request FormPDF

Updated: 01.08.24

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