Appealing Denials from Other Review Contractors

A redetermination (first level appeal) may be requested if a denial is received from another review contractor such as Comprehensive Error Rate Testing (CERT), the Office of Inspector General (OIG), Recovery Auditor (RA), Supplemental Medical Review Contractor (SMRC), or the Unified Program Integrity Contractor (UPIC). When requesting a redetermination, be specific about why the appeal is being requested. Submit medical records along with additional documentation to support the medical necessity of the item(s) denied. For more information about the appeals process refer to the Redetermination webpage on the Noridian website.

To find out more regarding why the denial may have occurred, please use the Noridian Denial Code Resolution Tool.

Last Updated Jan 11 , 2023