Article Detail - JF Part A

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

• Noridian Appeals Tutorials
• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 29, Appeals of Claims Decision