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Printed Date: 9/22/2015
A redetermination is the first of five appeal levels available for providers to contest initial claim determinations. You can file a redetermination request with Railroad Medicare through our free internet portal, eServices, by fax at (803) 462-2118, or via the esMD mechanism, but with whichever method you choose, you must include documentation to support your appeal.
As you select the supporting documentation for your request, keep the following information in mind:
Note: Claims rejected as unprocessable with remark code MA130 have no appeal rights and should not be submitted as redetermination requests. Please make the appropriate claim correction and resubmit the claim.
Appeals for Multiple Claims Involving the Same Issue
If multiple claims involve the same issue, it is not necessary to submit each appeal separately. You may file a single appeal for multiple claims. If multiple claims involve the same issue, you may submit one appeal request with all claims included. All appeal requests must be submitted in writing. Each claim in a multiple request must be clearly identified in some manner to allow identification of:
To ensure you receive a successful decision on single or multiple appeal requests, review the five key items listed below:
Note: All redeterminations must be received within 120 days from the date of receipt of the initial determination. The receipt of the initial determination is presumed to be five days from the date of the notice.
Once the redetermination request is completed, Railroad Medicare will provide a written response. The response will depend upon Railroad Medicare’s decision:
Railroad Medicare Redetermination forms are available on our forms page. Only one form is needed for a 'multiple appeal' request. For a 'multiple appeal' request, complete the form using the information for the first claim in question. In the Reason for Request box, indicate 'multiple request' along with the reason for the appeal.
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Last Updated: 07/03/2019