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How do I request a reconsideration?

How do I request a reconsideration?

To request a reconsideration with the appropriate QIC, follow the instructions on your Medicare Redetermination Notice. If you need help, please call 1-800-MEDICARE (1-800-633-4227).A request for reconsideration may be made on a standard CMS form. This form will be mailed with the Medicare Redetermination Notice. If the form is not used, the request must contain at least all of the following information:

  • The beneficiary's name
  • The beneficiary's Medicare health insurance claim number
  • The specific service(s) and item(s) for which the reconsideration is requested, and the specific date(s) of service
  • The name and signature of the party or representative of the party
  • The name of the contractor that made the redetermination

The Medicare Reconsideration Request form is located at: http://www.cms.hhs.gov/cmsforms/downloads/CMS20033.pdf

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