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:
- Medicare Claims Processing Manual (Pub 100-04 Ch. 29)
- The Appeal Process Quick Reference
- Adjustments or Add-ons to Appealed Claims
- Medicare Appeals Process: Five Levels to Protect Providers, Physicians, and Other Suppliers