- Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)
- Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)
- Five Levels of Appeals
- Request a Redetermination
- Request a Redetermination
- Request a Redetermination
- Request a Redetermination
- Submit a Reconsideration
- Submit a Reconsideration
- ALJ Hearing
- Medicare Appeals Council Review
- Federal Court Review
Request a Redetermination
The first level of appeal is the redetermination and is carried out by the MAC.
- Time limit to initiate = 120 days from date of receipt of the initial determination notice
- Time limit to complete the review = 60 days
- Amount in controversy = no minimum amount
Redeterminations may be submitted electronically or in writing.
Submit Your Redetermination Request
RECOMMENDED - Use NGSConnex
You can submit your redetermination requests using our free, secure Internet portal, NGSConnex. Follow the step-by-step instructions in the NGSConnex User Guide to submit your redetermination. If supporting documentation needs to be included with the redetermination, follow the instructions to add the documentation.
Note: There are no file size limitations to the attachments that can be submitted in NGSConnex; the only file types not accepted are: .xml, .log and .cfg.
Note: If there are multiple services on the same claim in question (same ICN), you only need to submit a single redetermination/reopening request. You should not submit multiple redetermination/reopening requests for the same claim.
By Mail
To request an appeal in writing, complete the Part A Redetermination Request Form – Level 1 and return to the appropriate National Government Services appeals mailing address.
J6 Mailing Address:
National Government Services, Inc.
Appeals Department
P.O. Box 6474
Indianapolis, IN 46206-6474
JK Mailing Address:
National Government Services, Inc.
Appeals Department
P.O. Box 7111
Indianapolis, IN 46207-7111
Please share your thoughts about your experience with our redetermination process.