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Redetermination

The first level of an appeal, a Redetermination, is a request to review a claim when there is a dissatisfaction with the original determination. A Redetermination is an independent re-examination of an initial claim determination.

Time Limit for Filing Request Time Limit to Complete Appellant's Request Where to File Form Filing Options
120 days from initial determination date or 120 days of initial overpayment 60 days from receipt date Contractor Redetermination [PDF]

 

Situations Claims Cannot be Appealed

  • Claim status/tracer questions, use Interactive Voice Response (IVR)
  • Medicare Secondary Payer (MSP) Inquiries
  • General Written Inquiries
  • Provider Address or Assignment changes, contact Provider Enrollment
  • If you have received a Redetermination decision regarding this issue; you must request a Reconsideration from QIC

Last Updated Nov 08, 2016