Redetermination Request Checklist - JA DME

• Review Standard Paper Remittance (SPR) or Medicare Electronic Remittance Advice (ERA) for claim(s) you are requesting a Redetermination on. Is ERA or SPR from Noridian?
  • If not, submit request for Redetermination to appropriate Durable Medical Equipment Medicare Administrative Contractor (DME MAC) identified on ERA or SPR

• Was the claim(s) in question denied with an appealable ANSI code?
  • If not, claim(s) denied as unprocessable and supplier must correct and resubmit claim(s)
• Does the ERA or SPR indicate a remittance advice remark code of MA01?
  • If so, appeal rights are available.

• Is claim denial due to a minor clerical error or omission (e.g., units of service, service dates, HCPCS coding, diagnosis codes, etc.)?
  • If so, submit a Reopening request. Most reopenings can be submitted through the Noridian Medicare Portal or in writing through mail, fax. Some still require a telephone reopening.

• What was date of final determination indicated on ERA or SPR? Have more than 120 days lapsed since the final determination?
  • If so, requestor must provide "good cause" detailing reason for filing late.

Have you reviewed all information listed above? If so, you are now ready to complete a Redetermination.

• Electronic Submission
  • Submit via NMP. It's fast, secure and economical - Log In Now
  • Access educational resources, learn how to register and view user manual on NMP webpage
• Paper Submission
  • Access the Medicare DME Redetermination Request Form or the CMS-20027 Medicare Redetermination Request Form - One request form per beneficiary and claim control number (CCN)
  • Send completed form and any applicable documentation (may include the Advance Beneficiary Notice of Noncoverage (ABN), medical records, supplier documentation, etc.) to appropriate Mailing Addresses or fax number