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Did You Know? Submitting instant online Redetermination Requests is one of the many benefits of myCGS.

Click HERE to learn more and complete the quick registration process!

Submitting Redetermination Requests

Below are the simple steps to follow after verifying that submitting a redetermination request is appropriate and that you are submitting your request within the allowable timeframe.

myCGS - Submit Electronically

Please note that providers have two options to submit Redetermination Requests: through the mail or through the secure web portal, myCGS. Submitting requests through myCGS saves time and money. If you are a registered user, learn more about submitting redetermination requests through myCGS in chapter 7 of the User ManualPDF, "Messaging and Forms."  Not a registered user yet?  Find out more about how to make myCGS work for you on the myCGS page.

esMD - Submit Electronically

The esMD system allows CGS to electronically receive redetermination requests, the first level of appeal.  Submit and complete the Medicare Part A Jurisdiction 15 Redetermination Request FormPDF when using esMD.  For information about esMD and how to obtain access, refer to the Centers for Medicare & Medicaid Services (CMS) esMD "Information for ProvidersExternal Website" Web page.

Submit on Paper

To submit a Redetermination Request on paper (through the mail), follow these steps:

  1. Access the Medicare Part A Jurisdiction 15 Redetermination Request FormPDF
  2. Complete ALL fields of the Redetermination Form.  Tip: complete the form electronically and print. Any redetermination request received that is not completed will be dismissed.
    • Save re-work and time!  Before mailing your request, double-check these three items:

      1. All forms must contain a requestor name.
      2. The request form must include the appropriate claim number (DCN) found on the initial determination being appealed.
      3. Is your redetermination request related to an overpayment?  If yes: check the appropriate box on the "overpayment appeal" line to stop recoupment and prevent delays.
  3. Mail the completed form and supporting documentation in the same envelope to:

    Attn: J15 Part A Appeals Department
    P.O. Box 20006
    Nashville, TN 37202

Updated: 07.08.19

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