Note: MACs do not process claim corrections involving minor errors and omissions through the appeals process. The contact information for each MAC can be found using the following link: /Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/Who-are-the-MACs#MapsandLists. Most MACs allow electronic submission of appeals through their website.
Check the MAC website for more information on how to file appeals.
The redetermination request must be sent to the MAC that made the initial claim determination (this information is on the MSN and the RA). A minimum monetary threshold on the claim is not required to request a redetermination. The appellant should include with their redetermination request any and all documentation that supports their argument against the previous decision.
The notice of initial determination is presumed to be received 5 calendar days after the date of the notice, unless there is evidence to the contrary.Ī redetermination must be requested in writing. The appellant (the individual filing the appeal) has 120 days from the date of receipt of the initial claim determination to file a redetermination request. Requesting a RedeterminationĪn initial determination decision is communicated on the beneficiary's Medicare Summary Notice (MSN), and on the provider's, physician's and supplier's Remittance Advice (RA). A redetermination is a review of the claim by Medicare Administrative Contractor (MAC) personnel not involved in the initial claim determination. Any party to the initial claim determination that is dissatisfied with the decision may request a redetermination.