Medicare Redetermination Request

CMS-20027 · CMS

First-level appeal for Original Medicare (Part A/B) claim denials. Must be filed within 120 days of the initial determination.

Form Details

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Where to Submit This Form

📬

Mail to your Medicare Administrative Contractor (MAC)

The address is on your Medicare Summary Notice (MSN).

Filing Deadline

Within 120 days of receiving the Medicare Summary Notice (MSN) showing the denial.

Processing Time

60 days for a decision.

What Happens Next

The MAC will issue a redetermination. If still denied, you can appeal to the Qualified Independent Contractor (QIC).

Tips for This Form

✓ Include a letter of medical necessity from your doctor
✓ Reference the specific Medicare coverage rule that supports your claim
✓ Keep copies of everything you send

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