Change in the First Level of Appeal: Redeterminations

A redetermination is an examination of a claim by Carrier personnel who are independent of the personnel who made the initial determination. The appellant (the individual filing the appeal) has 120 days from the date of receipt of the initial claim determination to file an appeal. A redetermination can be requested in writing or over the telephone to the local Medicare Carrier. No monetary threshold is required to be met.

Requesting a Redetermination in Writing

A request for a redetermination can be filed on Form CMS-20027 or in writing. The request must include:

• Beneficiary name
• Medicare Health Insurance Claim (HIC) number
• Specific service and/or item(s) for which a redetermination is being requested
• Specific date(s) of service
• Signature of the party or the appointed representative of the party

With a written request, the appellant should attach any supporting documentation.