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Request a redetermination by mailing your Medicare statement (with the denied items circled) or a completed CMS Form 20027 to the address in Step 7 on the last page of your notice. File by the deadline printed on your notice, counting from the date on the letter itself.
A redetermination is the first level of the Medicare appeals process, handled by your Medicare Administrative Contractor (the company that processes your Medicare claims). It's the right starting point when Original Medicare (Parts A or B) denies a claim on your Medicare statement, the quarterly notice that lists what Medicare paid. If your denial came from a Medicare Advantage plan or a Part D drug plan instead, the process is different: Advantage plans call the first level a reconsideration and set their own deadlines, so follow the instructions in that denial letter rather than this guide.
| Step | Detail |
|---|---|
| Read the MSN | Find the denied items and the reason code (e.g. "not medically necessary") |
| Prepare your package | Circle the denied items on a COPY of the MSN and write your reasons, or use CMS Form 20027 |
| Include your details | Name, phone number, and Medicare number on every document you send |
| Attach support | Copies of medical records, a letter from your doctor, the original bills |
| Mail it | To the address in Step 7 on the last page of your MSN; certified mail for proof |
Count from the date printed on the notice itself, not the day it arrived in your mailbox. The MSN gives you a filing window for the redetermination, and missing it can end the appeal before it starts. If you can't meet the deadline for a good reason, Medicare's appeals guide notes that you may still file and get a decision if you can show good cause for the delay, like an illness or accident that kept you from filing on time. Don't count on that exception: file early.
No, and this is a detail many people miss. Medicare's own appeals guide says you can simply explain in writing on your MSN or a separate piece of paper why you disagree with the decision. The Redetermination Request Form (CMS Form 20027) is available from CMS's forms library or by calling Medicare, but a clear letter covering the same ground works just as well. Whichever you use, include your name, phone number, Medicare number, the specific items or services you're appealing, and why you believe the denial was wrong. Write your Medicare number on every page you send.
Not to Medicare headquarters. Your appeal goes to the Medicare Administrative Contractor's claims office, and the correct address is printed in Step 7 on the last page of your MSN. Different contractors serve different regions, so the address on your notice is the only one that counts: mailing it to the wrong contractor is a classic delay. Send it certified mail so you have a dated receipt proving it arrived within the window, and keep copies of everything you sent.
The contractor reviews your case and issues a redetermination notice. If it approves the service, the item shows up as paid on your next MSN. If it upholds the denial, you can take the next step: reconsideration by a Qualified Independent Contractor, which has its own deadline printed on the redetermination notice. The appeals path continues from there through an administrative law judge hearing and further levels, each with deadlines that restart at every step.
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