Appeals Decision Tree - JF Part A
Appeals Decision Tree - Can My Claim be Appealed?
My claim has denied. Can it be appealed?
Is your claim in a finalized status of D BXXX7, R BXXX7, or P BXXX7?
Please wait until the claim is in a finalized status of D BXXX7, R BXXX7, or P BXXX7 before submitting a redetermination request.
If you are unsure about the location of your claim please review the remittance advice. Any further questions, please contact the IVR for claim information.
Do you want to appeal the Medicare decision?
No appeal is necessary if you agree with the initial claim determination.
Is the line you are trying to appeal rejected with one of the following reason codes: W7020, W7021, W7039, or W7040?
This line is not appealable. Please correct coding and resubmit claim.
Does this claim relate to issues involving Medicare Secondary Payer?
Please see MSP for further information.
Has a redetermination decision been issued for this claim?
A redetermination has already been completed on this claim. A reconsideration is the next step in the appeal process.
Does this claim meet the timeliness guidelines to appeal? The Appeals Timeliness Calculator can assist in determining timeliness.
This claim does not have appeal rights unless good cause can be shown for late file. More information on Good Cause for late filing can be found in the Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 29, Section 60.7.
Are you an appointed representative appealing on behalf of the provider or beneficiary?
Last Updated Wed, 29 Apr 2020 20:05:42 +0000