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October 10, 2023

myCGS: Access Redeterminations (1st Level Appeal) Form from the CLAIMS Tab

Many Redetermination requests submitted through myCGS are dismissed because the form is not completed correctly; digits of the Internal Control Number (ICN) are transposed, codes and modifiers added to the form are not on the original claim/CGS remittance advice, etc. These errors occur because myCGS users oftentimes accessed the Redeterminations form from the FORMS tab instead of the CLAIMS tab.

TIP: Accessing the Redeterminations form from the CLAIMS tab is most efficient, as most fields will auto-populate with the information we need to successfully process your requests!

To reduce errors and dismissals due to incorrect/incomplete forms, while increasing our processing rate, you can access the Redeterminations form under only the CLAIMS tab.

To submit a Redetermination, go to the CLAIMS tab and search for the claim. If the claim is still within the timeframe for a Redetermination (120 days of the initial determination), the Request Redetermination button will be available.

Request Redetermination

Click on the button and the form will auto-populate with most of the details we need. No more keying errors and transposed numbers!

If you have “good cause”External Website to submit your Redetermination after the 120 day timeframe and the myCGS form is not available to you, you may complete the appropriate hardcopy Redetermination Request Form based on your line of business and type of claim: Home Health & HospicePDF, Part APDF, or Part BPDF.

Refer to the myCGS User Manual for help navigating various functions. If you’re not registered for myCGS, create your account TODAY!

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