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May 31, 2018 - Updated: 07.08.19

Avoid Redetermination Dismissals

When submitting a request for a redetermination, which is the first level of appeal, the request must include the following information.

  • Beneficiary full name;
  • Beneficiary’s Medicare identification number;
  • Specific services(s) and/or item(s) for which the redetermination is being requested;
  • Specific date(s) of service (To and From);
  • Printed name of requestor.

If the above information is missing, incorrect or incomplete, your redetermination request will be dismissed.  You may resubmit a completed redetermination; however it must be submitted within 120 days from the date of receipt of the notice of initial determination.  Please refer to the CMS Medicare Publication 100-04, Chapter 29, Section 310.6External PDF for additional information.

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