Redetermination Versus Reconsideration Forms - Appeals Newsletter Part 16

The Appeals team has identified that incorrect forms are being submitted for appeals. To ensure appeals are processed efficiently, it is critical to use the correct forms and submit them to the appropriate location. This article provides a summary of where appeals should be sent and which forms must be used for redeterminations and reconsiderations. To avoid submitting the incorrect form, Noridian encourages all providers to submit their appeals through the Noridian Medicare Portal (NMP).

Redetermination

  • Complete via Direct Data Entry (DDE)
  • Redetermination Form
    • Check Redetermination box (Type of Request section)
    • Send to:
      Redeterminations Medicare Part A
      Attn: Redeterminations
      PO Box 6720
      Fargo, ND 58108-6720
    • Fax Redetermination requests to: 701-277-7852

Reconsideration

  • Reconsideration Form
    • Send to:
      Maximus Federal Services
      3750 Monroe Ave.
      Part A West-Suite 706
      Pittsford, NY 14534

Appeals Resources

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