Fill out CMS-20027 (Medicare Redetermination Request) online
Form CMS-20027 is used to request the first level of appeal (redetermination) when a Medicare beneficiary, provider, or supplier disagrees with an initial Medicare coverage or payment decision. This is the first step in the Medicare appeals process.
How to fill out CMS-20027 (Medicare Redetermination Request)
Enter the beneficiary information
Provide the beneficiary's name, Medicare Beneficiary Identifier (MBI) number, address, and phone number.
Identify the claim being appealed
Specify the claim number, date of service, and the item or service that was denied or underpaid. Reference the Medicare Summary Notice (MSN) or Remittance Advice (RA) number.
Explain why you disagree
Provide a clear explanation of why you believe the initial determination was incorrect. Include any relevant medical facts, clinical details, or policy references that support your position.
Attach supporting documents and sign
Include any supporting documentation such as medical records, physician letters, or other evidence. Sign and date the form. If filing as a representative, include proof of authorization.
About CMS-20027 (Medicare Redetermination Request)
Who needs this form
Medicare beneficiaries, their authorized representatives, providers, or suppliers who disagree with an initial determination about Medicare coverage or payment for a specific claim.
Where to submit
Submit to the Medicare Administrative Contractor (MAC) that made the initial determination. The MAC's address is listed on the Medicare Summary Notice (MSN) or Remittance Advice (RA). Must be filed within 120 days of receiving the initial determination.
Source and content freshness
- Filing deadlines may shift for weekends and holidays. Verify due dates with official instructions.
Common mistakes to avoid
- Missing the 120-day filing deadline from the date of the initial determination
- Not identifying the specific claim(s) being appealed
- Failing to include the Medicare Beneficiary Identifier (MBI) number
- Not attaching supporting documentation (medical records, physician statements)
Frequently asked questions
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What happens after I submit a redetermination request?
The MAC will review your request and the supporting documentation. They will issue a decision within 60 days for Part A and Part B claims. If you disagree with the redetermination decision, the next level of appeal is a reconsideration by a Qualified Independent Contractor (QIC).
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