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1st Level of Appeal: Redetermination

Any party to an initial claim determination who is dissatisfied with the decision may request a redetermination (first level appeal). A redetermination is a claim review by CGS staff not involved in the initial claim determination.

Form & Checklist

Time Limit for Filing Request

120 days from the initial determination notice (Remittance Advice) receipt date

Monetary Threshold to be Met

None

Submission Methods

Helpful Tips

  • Redetermination Request Form – Ensure this is the first document (page 1) of your request.
  • Appointment of Representative (AOR) – If acting as a party’s representative, include a valid CMS-1696External PDFor written notice that includes all required elements. AORs are valid for one year from the date it contains both the party’s and appointed representative’s signatures (unless the party provides a written statement to revoke the representative’s authority).
  • Demand letter – If appealing a claim overpayment decision, include a copy of the demand letter and any associated attachments.
  • Documentation – Submit any and all supporting documentation. This may include legal briefs; however, these aren’t necessary for the appeal review and don’t increase the likelihood of a favorable outcome.
  • Multiple Beneficiary/Single Appeal Request SpreadsheetPDF – Use this form to file a single appeal for multiple beneficiaries. If appealing a UPIC decision, submitting the UPIC notification letter as a claim list isn’t the best practice.
  • Timeframe – CGS has 60 days to process an appeal.
  • myCGS portal – Registered users can submit electronic requests and receive immediate notifications.

Updated: 09.09.2025

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