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Medicaid Redetermination (also known as Medicaid Recertification, or Medicaid Renewal) is the regular eligibility review that each states Medicaid agency conducts to determine whether beneficiaries still qualify for Medicaid or Childrens Health Insurance Plan (CHIP) coverage.
There are 2 ways that a party can request a redetermination: Fill out the form CMS-20027 (available in Downloads below). Make a written request containing all of the following information: Beneficiary name. Medicare number. Specific service(s) and/or item(s) for which a redetermination is being requested.
Any party to the initial claim determination that is dissatisfied with the decision may request a redetermination. A redetermination is a review of the claim by Medicare Administrative Contractor (MAC) personnel not involved in the initial claim determination.
Redeterminations of SSI eligibility. (a) Redeterminations defined. A redetermination is a review of your eligibility to make sure that you are still eligible and that you are receiving the right amount of SSI benefits.
Requested information can be submitted by mail, in person, online, or phone. Members can submit information online by logging in or creating an online account at benefitscal.com. To submit information by phone, members can call DPSS at 1-866-613-3777 Monday Friday from 7:30 a.m. 6:30 p.m. (excluding holidays).
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People also ask

If you submitted a claim to Medicare and you were denied either full or partial payment, you can appeal this payment denial. This is called a request for redetermination. If you are not happy with the redetermination decision, you can request a reconsideration.

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