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 Manual, "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 Form when using esMD. For information about esMD and how to obtain access, refer to the Centers for Medicare & Medicaid Services (CMS) esMD "Information for Providers" Web page.
Submit on Paper
To submit a Redetermination Request on paper (through the mail), follow these steps:
- Access the Medicare Part A Jurisdiction 15 Redetermination Request Form
- 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:
- All forms must contain a requestor name.
- The request form must include the appropriate claim number (DCN) found on the initial determination being appealed.
- 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.
- Mail the completed form and supporting documentation in the same envelope to:
CGS
Attn: J15 Part A Appeals Department
P.O. Box 20006
Nashville, TN 37202
Updated: 12.06.23