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1st Level of Appeal: Redetermination
Any party to an initial claim determination who is dissatisfied with the decision may request a redetermination (first level appeal). A redetermination is a claim review by CGS staff not involved in the initial claim determination.
Form & Checklist
Time Limit for Filing Request |
120 days from the initial determination notice (Remittance Advice) receipt date
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Monetary Threshold to be Met |
None |
Submission Methods |
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Helpful Tips |
- Redetermination Request Form – Ensure this is the first document (page 1) of your request.
- Appointment of Representative (AOR) – If acting as a party’s representative, include a valid CMS-1696
or written notice that includes all required elements. AORs are valid for one year from the date it contains both the party’s and appointed representative’s signatures (unless the party provides a written statement to revoke the representative’s authority).
- Demand letter – If appealing a claim overpayment decision, include a copy of the demand letter and any associated attachments.
- Documentation – Submit any and all supporting documentation. This may include legal briefs; however, these aren’t necessary for the appeal review and don’t increase the likelihood of a favorable outcome.
- Multiple Beneficiary/Single Appeal Request Spreadsheet
– Use this form to file a single appeal for multiple beneficiaries. If appealing a UPIC decision, submitting the UPIC notification letter as a claim list isn’t the best practice.
- Timeframe – CGS has 60 days to process an appeal.
- myCGS portal – Registered users can submit electronic requests and receive immediate notifications.
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Updated: 09.09.2025