Corporate

January 13, 2014 - Revised: 01.09.19

Resubmitting Claims Sent for Appeal

Recently, we have noticed an increase in the number of claims sent for Appeal that have been resubmitted as new claims. This issue affects appeals at various levels, including Redeterminations, Reconsiderations (second-level appeal) and Administrative Law Judge (ALJ) hearings (third-level appeal).

Resubmitting a claim that you have already appealed does not reduce the amount of time contractors have to process Appeals. In fact, it may cause problems and/or delays with processing and finalizing the outstanding appeal. Therefore, please do not resubmit claims that have been sent for appeal. If you have billing software that automatically resubmit claims that are pending in your system (whether pending the outcome of initial processing or an appeal), we suggest you have this feature disabled.

Submitting duplicate claims results in increased workload and causes processing delays. If you need additional information regarding appeals and the processing time allowed at each level, please refer to the resources below.


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