Redetermination questionnaire form 2025

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A redetermination is the first level of the Medicare Appeals Process. All requests should be submitted within 120 days of the initial claim determination. Appellants should attach any supporting documentation to their redetermination request.
WHAT IS A REDETERMINATION? We review your non-medical eligibility factors (i.e., income, resources, and living arrangements) to determine whether you are still eligible for and receiving the correct SSI payment.
A redetermination is a review of the claim by Medicare Administrative Contractor (MAC) personnel not involved in the initial claim determination.
If your redetermination is unfavorable, you will receive an MRN which explains the rationale that was used in upholding the original claim determination. In instances where a redetermination is considered partially favorable, CGS will generate an SPR or ERA as well as an MRN.
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.
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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.
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.

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