Save Time and Money by Submitting your Appeals (Reopenings & Redeterminations) Electronically

Two easy ways to submit.

National Government Services will now allow Medicare Part A and Part B providers to submit claim appeal requests, including medical record documentation, through electronic transactions rather than a paper appeal form. We offer 2 ways to submit your appeals electronically:

1. NGSConnex.com, our secure provider portal
2. Using your current practice management software systems X12 275 transaction capability

Submit an Appeal Electronically with NGSConnex

You can submit redetermination or reopening requests electronically through NGSConnex. To determine if your appeal qualifies as a reopening or redetermination, access the About Appeals page. All other appeals must be submitted by mail to the appropriate Medicare contractor. For information on other types of appeals, check the Levels of Appeals and Time Limits for Filing page. You can save mail time and print cost by submitting your appeals electronically.

If you are a current NGSConnex user, simply follow the step by step instructions found at Initiate Redeterminations/Clerical Error Reopenings

If you are not yet using NGSConnex, now is the time to learn about all the great features of our provider portal. To learn more about NGSConnex and to become a registered user, visit our NGS User Guide and learn how to save time and money.

Submitting an Electronic Appeal Request Using the X12 275 Version 6020 Transaction

Providers can now use the 275 electronic transaction to request a first level appeal which may include additional documentation.

The purpose of the appeals process is to ensure the correct adjudication of previously processed claims. The appeal can take the form of a reopening a reprocessing of a claim to fix minor mistakes, or a redetermination - an examination of a claim that includes analysis of documentation. To learn more about the appeals process visit About Appeals on our website.

When a provider is requesting an appeal using the 275 transaction it is required to include:

• The value of 15 in BGN01
• The request for the appeal using:
  • Completed Level 1 Redetermination Request Form
    • Part A Redetermination Request Form
    • Part B Redetermination Request Form

or

• A letter that includes the following:
  • Beneficiary name
  • Medicare number/MBI
  • Specific service/items for which the appeal is being requested
  • Specific dates of service
  • Name of the party or representative of the party (the provider)

Providers already enrolled to send the 275 transaction as unsolicited documentation to support the claim or as a solicited response to a request for documentation, will NOT have to enroll to send electronic appeals. The 275 enrollment includes sending documentation to support the claim and the first level appeal request.

We support up to ten separate documents sent in the 275 for one claim (up to ten iterations of the LX loop within each ST/SE).

For additional information on the 275 transaction see the NGS 275/HL7 Claim Attachment Companion guide located in the EDI Solutions section of our website.

Next Steps: You will need to contact your software vendor, system maintainer or clearinghouse to determine the process for your practice management/claim submission software.

We are excited to be able to offer this next level of automation to our provider community.

Related Content

• Standard Companion Guides
• Levels of Appeals and Time Limits for Filing
• Reopening versus Redetermination

Published 11/30/2021