Attention: Invalid Recoupment IssueCahaba GBA is experiencing a large number of Medicare Part A 935 Level 1 redetermination requests at this time. There have been some delays in processing these requests which includes stopping recoupment on these claims. If an invalid recoupment occurs, we will work as quickly as possible to refund the improper recoupment. Please be aware that when a 935 refund is issued, there will be both principal and interest returned to the provider. Once you have been notified of a refund, expect your refund within 3 business days. In order to help read your remittance, please see remit instructions on the CMS website. Please be sure to file your appeal as quickly as possible in order to avoid an invalid recoupment. Those received on the 30th day are more likely to have issues. In addition, filing using the Redetermination SMART Form will help Cahaba reduce processing time. Posted: September 4, 2013
Redetermination SMART Form
The first level of an appeal is a written redetermination. Cahaba GBA has developed an interactive Redetermination SMART Form that may be used to submit your request for a redetermination. This electronic form is convenient for the provider and designed to be filled out by typing directly into the form.
Appeals Decision Tree
Do you need to file an appeal on your previously submitted claim? The Appeals Decision Tree is a tool with a series of questions designed to assist the provider in determining if an appeal needs to be filed to Cahaba GBA.
The Appeals Calculator is a helpful tool used to determine the date your appeal request must be received to meet timeliness guidelines.
A provider or beneficiary may appeal an initial claim determination when Medicare’s decision is to deny or reduce payment based on §1862(a)(1), §1834(a)(17)(B), §1834(j)(1), or §1834(a)(15).
Medicare provides five (5) possible levels of appeal in the following order:
- Administrative Law Judge (ALJ) Hearing
- Appeals Council Review
- Final Judicial Review
For additional information, refer to the following items:asdf a
- The Medicare Appeal Process Quick Reference Tool
- Adjustments or Add-ons to Appealed Claims
- Medicare Appeals Process: Five Levels to Protect Providers, Physicians, and
Page last updated:
October 24, 2012