General Question for the Week of June 20, 2016

General Compliance Question of the Week

Question:

For Original Medicare (Part A and Part B), where can I find the address to send a first level appeal (redetermination)?

Answer:

A first-level appeal (redetermination request) is sent to the Medicare administrative contractor (MAC) that issued the initial determination on the claim. 

When the MAC transmits the remittance advice (RA) for initial determinations, it is supposed to send instructions on how to file an appeal. If you do not have those instructions, you can find the appeals address on the MAC’s website. To locate the MAC for your area (state), http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/provider-compliance-interactive-map/index.html

If you need further information on filing an appeal, see the instructions at: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MedicareAppealsProcess.pdf

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.