Appeals Decision Tree - Part B
1. Has your claim appeared on a Remittance Advice?
2. Does the Remittance Advice show your claim has been rejected as unprocessable with MA-130?
You have no appeal rights. You must correct the claim and resubmit as new claim.
3. Was everything submitted correctly on the claim?
4. Have you filed a redetermination on this claim previously?
5. Have you received your decision?
File a Reconsideration request to the Qualified Independent Contractor (QIC).
Please allow 60 days for completion. If not sure, appeal status is available in myCGS or the IVR.
5. Did your claim deny for untimely filing?
Your claim is not eligible for appeal. If you feel you have good cause to reopen your claim, submit a Reopening using myCGS or the Clerical Error Reopening Form.
6. Is the date of the initial determination within 120 days?
7. Is Medicare the secondary payer for this claim?
For claims that have been denied for no MSP info or if MSP record has been updated, submit a Reopening using myCGS or the Clerical Error Reopening Form.
Your appeal rights have expired.
Claim submitted untimely or with minor omissions/errors. Submit a Reopening using myCGS or the Clerical Error Reopening Form.
Please wait until you have received your Medicare Remittance Advice with notice your claim is complete.