News-At-A-Glance: Noridian Redetermination Request Update

In a notice posted on March 5, Noridian Healthcare Solutions reminds providers requesting redeterminations about submission of documentation. The update reminds providers that the requests must be in writing, either in a letter or on the Centers for Medicare and Medicaid Services (CMS) Form 20027, and include what the appeal concerns and the reason providers are appealing. Redetermination requests must include the beneficiary name, Medicare claim number, the specific services and dates for which the redetermination is being requested, and the name and signature of the requesting party at a minimum. Providers should send only one form or letter per denial. Documentation to support the request must be included or attached, meaning that all applicable documentation related to the claim or line item being appealed. If the request involves an Advance Beneficiary Notice, include the signed notice. The update also includes a list of resources available to providers to assist with the process. CMS has previously reported extremely long delays of appeals at the administrative law judge level of the appeals process, so it is to a provider’s advantage to try to resolve problems at the redetermination level of the process. Even though the notice is published by Noridian, understanding how to facilitate the redetermination process by submitting all necessary documentation should help any provider regardless of the Medicare Administrative Contractor involved.