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October 9, 2018

Avoiding Unnecessary Redetermination Dismissals

CGS Appeals department has noticed an increase in Redetermination Appeal requests for claims that have not yet completed processing in the Fiscal Intermediary Standard System (FISS). Providers utilizing the myCGS Portal may receive Medical Review Claim Decision letters when the claim is in FISS status/location S B9099; however, to avoid redetermination dismissals and appeal a claim, the claim must be denied (FISS status/location D B9997) or partially denied (P B9997).

For additional information, refer to the following resources:

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