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January 22, 2016

Denial Message - 56900 (Non-Receipt of Records)

A large volume of Medical Review Reopening requests are being submitted to the Appeals department in error. This action delays the correct processing of your claims. Claims that originally denied for missing the 45-day records submission deadline do not usually need a determination letter from Appeals. Consider these important tips:

  1. If it's still within 120 days of the remittance advice date and you want to submit the records, send the records to Medical Review and ask for a Reopening at:
    J15 Part A Medical Review
    PO Box 20021
    Nashville, TN 37202
    FedEx/UPS/Overnight Courier:
    CGS J15 Part A Medical Review
    26 Century Blvd STE ST610
    Nashville, TN 37214-3685
    Fax: 803.462.2596
  2. If Medical Review denies the claim and you disagree with the determination, a Redetermination (appeal) is your next step.
  3. If it has been more than 120 days from the remittance advice date, submit the records to Appeals with a complete and concise Redetermination Request (preferably via the myCGS portal). Click here to learn more about the myCGS portal. Uploading documents is easier than ever!

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