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07/02/2014

Redetermination Tips

Redetermination Tips and Reminders
Please follow these tips to ensure that your Redetermination requests are processed accurately and as quickly as possible:
*When you complete the Redetermination Request form, fill in all the information needed, including the date of service, CPT or HCPCS code in question, the correct ICN from your remittance advice, your signature and phone number
*If you are appealing an overpayment:
  -Use the ICN from the overpayment request, rather than the original paid ICN.
  -Include a copy of the Overpayment Demand letter. (Your appeal of the overpayment must be filed within 120 days of the date of the demand letter.)
  -Consider filing your Redetermination request electronically. Our secure web portal, myCGS, allows registered users to submit requests for Redetermination online. For more about this process, refer to the "Forms" section of the myCGS User Manual for step-by-step instructions.


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