AETNA TIMELY FILING FOR APPEALS HOW TO
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. An explanation of why the appellant disagrees with the contractor's determination.Name of the party, or the representative of the party.Specific service(s) and/or item(s) for which a redetermination is being requested.Make a written request containing all of the following information:.Fill out the form CMS-20027 (available in “Downloads” below).There are 2 ways that a party can request a redetermination: 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. Medicare Provider Cost Report Public Use FilesĪny party to the initial claim determination that is dissatisfied with the decision may request a redetermination.Provider statistical & reimbursement report.
Medicare fee for service for Parts A & B.Medicare Claims Synthetic Public Use Files (SynPUFs).Health Care Information System (HCIS) data file.Medicare Provider Utilization and Payment Data.
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