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Medicare Redetermination Notices (MRNs): Not Sent for Fully Favorable Redeterminations

When a redetermination is fully approved, an MRN (letter) is not sent. The Standard Paper Remittance advice (SPR) or the Electronic Remittance Advice (ERA), and the Medicare Summary Notice (MSN) for beneficiaries, are CGS's official notifications when the outcome of the Redetermination request is fully favorable.

If your redetermination is unfavorable, you will receive an MRN which explains the rationale that was used in upholding the original claim determination.

In instances where a redetermination is considered partially favorable, CGS will generate an SPR or ERA as well as an MRN.

Reminders:

  • You may file a Redetermination Request (first level of appeal) within 120 days of the date of the initial claim determination. In most cases, this is the date on your Remittance Advice.
  • CGS processes Redetermination Requests within 60 days of receipt (sometimes sooner). The Medicare Modernization Act of 2003 (MMA) ensures that redetermination decisions are made in a timely manner by requiring that 100% of redeterminations must be completed and mailed (if not fully favorable) within 60 days of the receipt of the request.
  • Submit Redetermination Requests electronically through the myCGS portal (must be registered): click on the myCGS link on the left side of the CGS website
  • The Medicare HHH Jurisdiction 15 Redetermination Request FormPDF (may be completed electronically, then printed and mailed with supporting documentation)

Reference: Medicare Claims Processing Manual (Pub. 100-04), chapter 29External PDF

  • Explanation of "initial determination": section 200.B
  • Steps in the appeals process: section 220

Updated 07.08.19

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