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Any party to the redetermination that is dissatisfied with the decision may request a reconsideration. A reconsideration is an independent review of the administrative record, including the initial determination and redetermination, by a Qualified Independent Contractor (QIC).
Fill out a Redetermination Request Form [PDF, 100 KB] and send it to the company that handles claims for Medicare. Their address is listed in the Appeals Information section of the MSN. Or, send a written request to company that handles claims for Medicare to the address on the MSN.
There are 3 ways to file an appeal: Circle the item(s) and/or services you disagree with on the MSN. Explain in writing why you disagree with the decision or write it on a separate piece of paper, along with your Medicare number, and attach it to the MSN. Include your name, phone number, and Medicare number on the MSN.
Submit a written request that includes: Your name and Medicare Number. The specific item(s) and/or service(s) youre requesting a reconsideration for and the specific date(s) of service. You can find this information in your Medicare Redetermination Notice.
Any party to the redetermination that is dissatisfied with the decision may request a reconsideration. A reconsideration is an independent review of the administrative record, including the initial determination and redetermination, by a Qualified Independent Contractor (QIC).

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Fill out a Redetermination Request Form [PDF, 100 KB] and send it to the company that handles claims for Medicare. Their address is listed in the Appeals Information section of the MSN. Or, send a written request to company that handles claims for Medicare to the address on the MSN.
A redetermination is the first level of the appeals process and is an independent re-examination of an initial claim determination. A claim must be appealed within 120 days from the date of receipt of the initial Medicare Summary Notice (MSN), Remittance Advice (RA) or Overpayment Demand Letter.
State Specific Exceptions CorrespondenceUSPSExtended Repayment ScheduleNoridian Medicare JE Part B Refund ATTN: Extended Repayment Schedule PO Box 511381 Los Angeles, CA 90051-7914Fraud and Abuse / Benefit ProtectionNoridian JE Part B Attn: Fraud and Abuse/Benefit Protection PO Box 6710 Fargo ND 58108-671011 more rows

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