Complete the Medicare Redetermination Request Form

Got a Medicare claim denial and feeling stuck? You’re not alone. The first thing you should do is fill out the Medicare Redetermination Request form. It’s the gateway to the first level of the Medicare appeals process, and getting it right can save you time, stress, and maybe even a lot of money.

In this guide I’ll walk you through everything you need to know—why the form matters, where to find it, how to fill it out step by step, what happens after you submit, and the common pitfalls that trip up most folks. Think of it as a friendly chat over coffee, with a few useful checklists and real‑world examples thrown in.

Why It Matters

Most people don’t realize that a claim denial isn’t the final word. Medicare’s appeal hierarchy starts with a redetermination, which is essentially a second pair of eyes reviewing the original decision. If you act within the 120‑day window, you keep the process moving quickly; miss that deadline and you might have to start over at a higher level, which can take months.

Redeterminations are also your chance to attach any missing documentation—doctor’s notes, lab results, or a signed Advance Beneficiary Notice (ABN). When you provide solid evidence up front, the chances of a favorable outcome go up dramatically.

Get The Form

The official form is CMS‑20027, titled “Medicare Redetermination Request Form – 1st Level of Appeal.” You can download the PDF straight from the official CMS website. Make sure you have the latest version (look for “Form CMS‑20027 (01/20)” on the first page).

If you’d rather fill it out online, services like pdfFiller let you edit, sign, and share the form electronically. Remember, these tools are just conveniences; the content must still match what CMS expects.

Step‑by‑Step Walkthrough

Below is a handy table that breaks down each section of the form, what you should enter, and tips to avoid common mistakes. Grab a pen, open the PDF, and follow along.

Section	What to Enter	Tips & Common Mistakes
Beneficiary Information	Name, Medicare Beneficiary Identifier (MBI), Date of Birth	Use the exact spelling and numbers from your Medicare Summary Notice (MSN). Mistyping the MBI will delay processing.
Claim Details	Service date, item or service appealed, HCPCS/Procedure code, ICN (if you have it)	Attach a copy of the original Remittance Advice (RA) or Medicare Summary Notice. The ICN is the best identifier for the claim.
Initial Determination Date	Date on the denial notice (must be ≤ 120 days old)	If you’re past 120 days, include a clear, honest reason for the late filing (e.g., “mail delayed in transit”). CMS often rejects late filings without an explanation.
Reason for Disagreement	Free‑text explanation—medical necessity, clerical error, coverage question, etc.	Be concise but specific. List bullet points: “Physician’s note says procedure medically necessary” and attach that note.
Evidence Submission	Check “I have evidence to submit” and attach PDFs now, or attach a statement of what you’ll send later.	All evidence must arrive before the redetermination is issued. Include operative reports, physician orders, lab results, and any ABN.
Overpayment Question (Providers/Suppliers only)	Yes/No. If Yes, include the overpayment demand letter number.	If you’re a provider, double‑check the demand letter; an incorrect number can cause a processing hold.
Contact Information	Phone, optional email.	Provide a phone number you answer regularly. CMS may call for clarification.
Signature & Date	Hand‑sign or use an electronic signature tool.	Electronic signatures are accepted when using approved fillable PDFs.

Attaching Evidence Correctly

CMS prefers PDF files under 5 MB each. Combine related documents into one PDF where possible (e.g., all physician notes in a single file). Label each file clearly, like “DoctorNote_2023-06-15.pdf.” If you’re mailing the form, use a sturdy envelope and include a copy of every document.

Submitting the Form

There are two main ways to send your redetermination request:

• Mail: Send the completed form and attachments to the address listed on the denial notice. For many contractors, the address depends on your state. For example, National Government Services (NGS) uses PO Box 7111 in Indianapolis for Part B appeals; see the form’s “Mail to” section for specifics.
• Electronic portal: Some Medicare Administrative Contractors (MACs) let you upload the form via their web portal. CGS Administrators, for instance, offers a “myCGS” portal where you can track status in real time. Check the contractor’s website for a “Redetermination” or “Appeals” tab.

Whichever method you choose, keep a copy of everything for your records. A scanned PDF saved on your computer works wonders if you later need to reference the submission.

After Submission

Once you’ve sent the form, Medicare has up to 60 days to issue a decision (according to the Noridian Medicare portal). You’ll receive a new notice—either approving the claim, denying it again, or offering a partial approval.

Tracking the Status

If your contractor offers an online portal, log in to see real‑time updates. Otherwise, you can call 1‑800‑MEDICARE (1‑800‑633‑4227) and provide your claim number and the date you mailed the request. Have the original denial notice handy; the rep will need it to pull up your file.

Possible Outcomes

• Approved: The claim is paid, and you’ll see the amount in your next Medicare Summary Notice.
• Denied: You’ll receive a second‑level denial (a “reconsideration” notice). This means you can move to the next step in the appeal ladder.
• Partial Approval: Some services may be covered while others remain denied. The notice will explain which items were approved and why the rest were not.

Beyond Redetermination

The Medicare appeals process has five levels. The redetermination is just the first. If you need to go further, here’s a quick snapshot of what’s next:

Level	Name	Form	Typical Timeline
1	Redetermination	CMS‑20027	≤ 60 days
2	Reconsideration	CMS‑20033	≤ 60 days
3	Administrative Law Judge (ALJ)	Request to ALJ	≈ 90 days
4	CMS Appeals Council	Appeal to Council	≈ 90 days
5	Federal Court	Litigation	Varies

If you’re heading to Level 2, you’ll need the Medicare Reconsideration Request form. The good news? Much of the information you already entered on the redetermination form can be reused, so you won’t start from scratch.

Common Pitfalls & How to Dodge Them

Missing Deadline

Easy to overlook, especially if the denial notice arrives by mail and you’re juggling health appointments. Set a calendar reminder for the day you receive the notice, and another reminder for the 120‑day cutoff.

Incomplete Evidence

CMS will dismiss a redetermination if you claim you’ll submit evidence later but never do. Pack everything you have now—physician’s notes, operative reports, lab results, and any correspondence that supports medical necessity.

Wrong Form for Your Situation

Medicare has separate redetermination forms for Part A (hospital), Part B (medical), and DME (Durable Medical Equipment). Using the Part B form for a hospital claim can cause a processing delay. The top of each form tells you which “jurisdiction” it serves; double‑check before you print.

Late Filing Without Explanation

If you’re past 120 days, you need a solid reason—like “the original notice was mailed to an old address” or “my primary caregiver was ill and couldn’t gather paperwork.” Blanket statements such as “I forgot” rarely persuade reviewers.

Real‑World Anecdote

Sarah, a 68‑year‑old retiree from Ohio, missed the 120‑day deadline because her daughter, who handles her mail, was out of state for a month. When Sarah finally submitted the form, she added a note explaining the delay and attached a copy of the daughter’s travel itinerary as proof. CMS granted a “late filing” waiver, processed the redetermination, and approved the claim. The moral? Honest, documented explanations can rescue a late filing.

Expert Tips & Resources

Consult a Medicare Appeals Specialist

Many community health centers have staff who specialize in Medicare appeals. A quick phone call can clarify whether your case qualifies for an expedited review.

Read the Privacy Act Statement

Every form includes a Privacy Act Statement that explains how your information may be shared with other government agencies. Understanding this helps you feel confident about the data you’re providing.

Downloadable Checklist

Below is a simple checklist you can print and keep at your kitchen table while you gather documents:

• Copy of denial notice (MSN or RA)
• Completed CMS‑20027 form
• All supporting medical records (physician notes, lab reports, ABN)
• Proof of timely filing (date you received the notice)
• Signed signature (hand or electronic)
• Mailing envelope or portal upload confirmation

Save this list as a PDF on your computer or print it out. Tick each item as you go—nothing feels better than checking a box.

Conclusion

Facing a Medicare claim denial can feel like hitting a wall, but the Medicare Redetermination Request form is your first key to unlocking a second review. Get the right form, fill every field accurately, attach all relevant evidence, and submit within the 120‑day window. If you stay organized and follow the steps above, you’ll increase your odds of a quick, favorable outcome.

Ready to start? Download the form, grab your documents, and take the first step toward getting the coverage you deserve. And remember—if you have questions or run into a snag, you’re not alone. Reach out to a local Medicare counselor, use the free resources on the official CMS site, or simply leave a comment below. We’re in this together, and you’ve got this!