Submitting instant online Redetermination Requests is one of the many benefits of myCGS.
Click HERE to learn more and complete the quick registration process!
Submitting Redetermination Requests
Below are the simple steps to follow after verifying that submitting a redetermination request is appropriate and that you are submitting your request within the allowable timeframe. Please note that providers have three options to submit Redetermination Requests: paper submission through the mail, electronically through the myCGS secure web portal or by using the Electronic Submission Medical Documentation (esMD).
myCGS - Submit Electronically
Please note that providers have two options to submit Redetermination Requests: through the mail or through the secure web portal, myCGS. Submitting requests through myCGS saves time and money. If you are a registered user, learn more about submitting redetermination requests through myCGS in the myCGS User Manual. Not a registered user yet? Find out more about how to make myCGS work for you on the myCGS page.
esMD - Submit Electronically
The esMD system allows CGS to electronically receive redetermination requests, the first level of appeal. Submit and complete the Medicare HHH Jurisdiction 15 Redetermination Request Form when using esMD. For information about esMD and how to obtain access, refer to the Centers for Medicare & Medicaid Services (CMS) esMD "Information for Providers " Web page.
Submit on Paper
To submit a Redetermination Request on paper (through the mail), follow these steps:
- Access the Medicare HHH Jurisdiction 15 Redetermination Request Form
- Complete ALL fields of the Redetermination Form. Tip: complete the form electronically and print. Any redetermination request received that is not completed will be dismissed.
Save re-work and time! Before mailing your request, double-check these three items:
- All forms must contain a requestor name.
- The request form must include the appropriate claim number (DCN) found on the initial determination being appealed.
- Is your redetermination request related to an overpayment? If yes: check the appropriate box on the "overpayment appeal" line to stop recoupment and prevent delays.
- Mail the completed form and supporting documentation in the same envelope to:
CGS – HHH Correspondence
CGS Administrators, LLC
P.O. Box 20014
Nashville, TN 37202
Updated: 12.03.21