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MEDICARE DME Redetermination Request Form (DME MAC Jurisdictions B & C) DME MAC JB & JC 2025

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The document is a Medicare DME Redetermination Request Form for Jurisdiction B and C, provided by CGS Administrators, LLC. It includes sections for supplier and beneficiary information, a checklist of suggested documentation for appeals, and instructions for submitting the form electronically. The form is intended for suppliers appealing overpayment determinations related to durable medical equipment.

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See more MEDICARE DME Redetermination Request Form (DME MAC Jurisdictions B & C) DME MAC JB & JC versions

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (34 Votes)
2012	4.2 Satisfied (42 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Who are the Medicare DME MACs?

A Medicare Administrative Contractor (MAC) is a private health care insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B (A/B) medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries.

How do I bill my Medicare DME claim?

When youre ready to submit the DME claim to Medicare, youll use the CMS-1500 form (also known as HCFA 1500). Claims should be submitted electronically to Medicare. CEDI is the Medicare contractor for submitting electronic claims to Medicare.

What states are covered by Palmetto?

DME MAC Jurisdiction C DME Facts JC processes FFS Medicare DME claims for Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Islands, Virginia, and West Virginia.

What states are in Medicare region C?

Administers the Medicare Part B (medical insurance) contract for the states of Illinois, Minnesota and Wisconsin serving nearly 165,000 Part B physicians and providers of service.

What states are in jurisdiction B for Medicare?

DME MAC Jurisdiction B - DME Facts JB processes FFS Medicare DME claims for Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin. Total Number of Fee-for-Service Beneficiaries: 5,653,232 (as of 9/30/2023) Total Number of Suppliers: 14,622 (as of 9/30/2023)

dme redetermination request form

Noridian DME Redetermination Form Medicare Redetermination form Part B Medicare Redetermination form Part A Noridian Redetermination Form Jurisdiction a Novitas redetermination form Medicare redetermination request form mailing address Medicare DME Fee Schedule Jurisdiction C Medicare DME forms for providers

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What states are in jurisdiction D for Medicare?

Palmetto GBA processes Part A, fee-for-service Medicare claims for Medicare beneficiaries through home health agencies and hospices in the following states: Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee and

What is jurisdiction C?

Jurisdiction C is serviced by CGS and includes Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virginia, West Virginia and the US Islands.

MEDICARE DME Redetermination Request Form (DME MAC Jurisdictions B & C) DME MAC JB & JC 2025

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