- What is an Appeal?
An Appeal is your opportunity to formally question how your claim was processed and/or paid. Use this section to review the Appeals options available to you.
- The 5 Levels of the Appeals Process
The Medicare program gives you the right to appeal a claim decision. This section provides detailed information on Redeterminations, Reconsiderations, Administrative Law Judge (ALJ), Departmental Appeals Board (DAB) Reviews and the Federal Court (Judicial) Review.
- Appeals Timelines
CMS has established specific timelines for each of the 5 levels of the appeal process. If you are planning to appeal a claim decision, use this section to locate timeliness requirements.
- How Do I Appeal An Overpayment?
This section provides important instructions on how to properly appeal an overpayment.
- Appeals Forms and Tools
We have created a variety of tools and forms to help you file your appeal in a timely manner. Use this section to locate the various online tools of benefit in your appeals process.
- Only Send What is Necessary for a Redetermination Request
The CGS Redetermination department is noticing that there is an increase in the amount of documentation sub mitted with redetermination requests. The first step in responding to a claim denial is to review the reason for the denial. Use the myCGS web Portal to learn why claims deny.
- Where Do I Send my Appeal?
Each level of appeal has a specific address and/or fax number. Use this section to locate the address and other relevant contact information for your specific level of appeal.