Modification to the Model Medicare Redetermination Notice (MRN)

Provider Types Affected
Physicians, suppliers, and providers who submit claims to Medicare contractors (Fiscal intermediaries (FIs), carriers, Part A/B Medicare Administrative Contractors (A/B MACs), DME Medicare Administrative contractors (DME/MACs), durable medical equipment regional carriers (DMERCs), and/or regional home health intermediaries (RHHIs)).

Provider Action Needed
The Centers for Medicaid & Medicare Services (CMS) issued change request (CR) 5554 in order to modify the Reconsideration Request Form and to amend the ALJ filing locations.

What You Need to Know
Providers and suppliers do not need to resubmit documentation when requesting a Qualified Independent Contractor (QIC) reconsideration if the documentation was previously submitted as part of the redetermination process. This documentation is forwarded to the QIC as part of the case file utilized in the reconsideration process. Make certain that any additional evidence is submitted prior to the reconsideration decision. If all additional evidence is not submitted prior to issuance of the reconsideration decision, you will not be able to submit any new evidence to the ALJ or further appeal unless you can demonstrate good cause for withholding the evidence from the QIC.

Be aware that when the service was rendered in Delaware, Kentucky, Virginia, Puerto Rico, and/or the US Virgin Islands, the filing locations for ALJ requests are modified to identify the appropriate Office of Medicare Hearings and Appeals (OMHA) field office. All other jurisdictions remain unchanged.

What You Need to Do
Make certain that your billing staff or other staff that handle reconsideration requests for you are aware of these changes.

Background
CR5554 is the official document that announces these changes in Medicare processes. Attached to this CR are three documents that assist with the appeals process:

• A sample form letter titled: Medicare Appeal Decision,
• A paper outlining Important Information About Your Appeal Rights, and
• A modified Reconsideration Request Form containing revised introductory instructions, as follows: “At a minimum, you must complete/include information for items 1, 2a, 6, and 7 but to help us serve you better, please include a copy of the redetermination notice you received with your reconsideration request.”

The revised filing locations for sending documentation for requesting ALJ hearings are as follows:

• Cleveland, Ohio is the filing location for services rendered in Delaware and Kentucky,
• Arlington, Virginia for services in Virginia, and
• Miami, Florida for services in Puerto Rico and the US Virgin Islands.

The following table lists the addresses of all filing locations along with the place of service:

Additional Information
For complete details regarding this Change Request (CR) please see the official instruction (CR5554) issued to your Medicare carrier, FI, A/B MAC, DME MAC, DMERC, or RHHI. That instruction may be viewed by going to http://www.cms.hhs.gov/Transmittals/downloads/R1229CP.pdf on the CMS website.

If you have questions, please contact your state’s Provider Contact Center.

MLN Matters MM5554