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Appeals - JF Part A

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Browse by Topic

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  • Appeals
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  • Documentation Requirements
  • Drugs, Biologicals and Injections
  • Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
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  • Noridian Medicare Portal (NMP) Claim Denial Details and Appeals This link will take you to an external website. - 08/31/21

Appeals

Access the below appeal level related information from this page.

  • Reopening
  • Redetermination - First Level
  • Reconsideration - Second Level
  • Administrative Law Judge (ALJ) Hearing - Third Level
  • Medicare Appeals Council Review - Fourth Level
  • Federal Court Review - Fifth Level

Resources

  • CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 29 - Appeals of Claims Decisions
  • CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 34 - Reopening and Revision of Claim Determinations and Decisions
  • CMS Medicare Learning Network (MLN) Matters Special Edition (SE)1426

 

Last Updated Thu, 27 Feb 2020 15:01:26 +0000

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  • Elements of a Redetermination Letter  
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  • Who Can Request an Appeal?  
  • CMS The Medicare Appeals Process: Five Levels to Protect Providers, Physicians, and Other Suppliers  
  • Washington Publishing Company (WPC) Remark Codes  

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