- Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)
- Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)
- Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)
- About Appeals
- About Appeals
- About Appeals
- Reopening versus Redetermination
- Who May File an Appeal
- Who May File an Appeal
- Who May File an Appeal?
- Who May File an Appeal?
- Levels of Appeals and Time Limits for Filing
- What Documents are Needed
- What Documents are Needed
- MSP Overpayments
- Submit an Adjustment to Correct Claims Partially Denied by Automated LCD-NCD Denials
- What Documents are Needed
- Submit an Appeal Electronically with NGSConnex
- Submit an Appeal Electronically via esMD
- Initiate Part B Reopenings or Non-MSP Overpayment Adjustments in NGSConnex
- Submit an Appeal Electronically via esMD
- What Documents are Needed
- Submit an Appeal Electronically via esMD
- Get Help Submitting an Appeal Hard Copy
- Get Help Submitting an Appeal Hard Copy
- Get Help Submitting an Appeal Hard Copy
- Submit an Appeal Electronically with NGSConnex
- Submit an Appeal Electronically via esMD
- Get Help Submitting a Appeal Hard Copy
- How to Prevent Duplicate Appeal and Clerical Error Reopening Requests in NGSConnex
- How to Avoid Costly Appeals
Submit an Appeal Electronically via esMD
CMS developed a mechanism for contractors to receive first level appeals electronically from providers via a secure gateway known as Electronic Submission of Medical Documentation, or esMD.
Some providers may be familiar with esMD, as it can also be used for submission of medical documentation in response to an additional development request (ADR) from a CMS review contractor. Any provider that wants to electronically submit medical documentation or first level appeals to a CMS review contractor must either:
- Build a gateway, or
- Procure gateway services from a Health Information Handler (HIH) of their choice
Note: The Appeals process is not changing. Providers will continue to be required to include a complete and signed CMS-20027 Medicare Redetermination Request Form (or other acceptable form of Appeal request or letter). The first page of the submission should be the appeal request.
You can learn more about signing up for esMD and choosing an HIH on the official CMS esMD web page.
Please share your thoughts about your experience with our redetermination process.
Helpful Resources
Log Into NGSConnex
Appeals Timeline Calculator
YouTube Video: Holistic Approach to Avoiding Administrative Burden
Form(s) you'll need: