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How Do I Appeal An Overpayment?

** DO NOT request a redetermination until you receive your Overpayment Demand Letter.**

When you receive the demand letter to refund an overpayment, it is in your best interest to immediately refund the requested amount. This will help you avoid an offset and accruing interest. When submitting a redetermination request regarding an overpayment, it is very important that you:

  • Complete the Redetermination Request Form in its entirety.
  • Provide the claim control number (CCN) of the adjusted claim that reflects the overpayment.
  • Include a copy of the audit results letter (for example, a notification letter from the contractor who audited your claims, such as the UPIC, RAC, Medical Review, etc.).
  • Include a copy of the overpayment demand letter (the official demand letter that is issued by CGS, containing the total amount of the overpayment, information on where to send payment, and appeal rights).
  • When preparing your request for an extrapolated appeal, it is very helpful if you prepare the documents in the following order:
    • Page 1: A letter identifying supplier, contact information, ARDCN, Invoice Number or Letter Number, reason for appeal, etc.
    • Page 2: A copy of the original demand letter that has the beneficiary names listed OR a complete list of beneficiary names, Medicare IDs, DOS, and items appealed.
    • Page 3: Documentation needed to support the appeal.
  • Submit one redetermination request per demand letter.

Note: Please specify in your request if you wish to appeal the entire amount of the overpayment demand letter or only certain claims. For cases involving multiple beneficiaries, it may be helpful to include a spreadsheet or list containing all of the items identified in bullet three above for each claim you wish to appeal.

Next, file the appeal using the Redetermination Request FormPDF:

  1. Select YES in the Overpayment Appeal section of the form
  2. Indicate who requested the overpayment (Medical Review, UPIC, CERT, SMRC, or Recovery Auditor)
  3. Submit your appeal using the information provided on the form. You can submit the form three ways:
*DME myCGS Web Portal

*The fastest and easiest way to submit redetermination requests.
Overpayment Appeals Fax 615.660.5976
Mail CGS – Jurisdiction B Redeterminations
PO Box 20007
Nashville, TN 37202



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