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Appeals

Welcome to the WPS Medicare Appeals web page.

Reopening Phone Number

(866) 590-6730
8:30 am to 11:30 am CT and
12:30 pm to 3:00 pm CT M-F
Redetermination Requests
IA KS MO NE
WPS Medicare Part B
Appeals Department
P.O. Box 8550
Madison, WI 53708-8550
WPS Medicare Part B
Appeals Department
P.O. Box 7238
Madison, WI 53707-7238
WPS Medicare Part B
Appeals Department
P.O. Box 14260
Madison, WI 53708-0260
WPS Medicare Part B
Appeals Department
P.O. Box 8667
Madison, WI 53708-8667

Overpayment Redetermination Requests

IA, KS, MO & NE
WPS Medicare Part B
Appeals Department
P.O. Box 14144
Madison, WI 53708-0144

Appeals Overview

Medicare allows beneficiaries, providers, and suppliers the right to appeal Medicare coverage and payment decisions. There are five levels of Appeal.

  1. Redetermination by a Medicare carrier, fiscal intermediary (FI), or Medicare Administrative Contractor (MAC).
  2. Reconsideration by a Qualified Independent Contractor (QIC)
  3. Hearing by an Administrative Law Judge (ALJ) in the Office of Medicare Hearings and Appeals
  4. Appeals Council Review
  5. Judicial Review in Federal District Court

Appeals Information

Appeal Fax Initiative
Appeals for Glycated Hemoglobin A1C Tests, Procedure Code 83036
Does Your Appeal Request Require Documentation?
Duplicate Appeal Requests
How to Appeal a Claim Determination
How to Correct a Claim without Requesting a Reopening
How to Request a Reopening
Important Tips about Documentation When Submitting Appeals on C-SNAP
Medicare Appeals - The Importance of Getting It to the Right Place at the Right Time!
Overpayment Redeterminations and Recoupment
Redeterminations on Overpayments
Unprocessable Claim Rejections Do Not Have Appeal Rights
Who Receives the Reimbursement for Fracture Care?

CMS Resources

CMS Appeals HomepageLink to external site
CMS Appeals Tri-Fold BrochureAdobe Portable Document format

Questions and Answers (Q&As)

Redeterminations Status Update

Reopening Calculator

WPS Medicare offers a reopening calculator to assist with the appeals process. Please access this calculator by selecting "Resources" within the top navigation bar.

Medicare allows beneficiaries, providers, and suppliers the right to appeal Medicare coverage and payment decisions. There are five levels of Appeal.

Forms

*Appeals and related forms are available within the Forms option of the top navigation bar, including:

* Fax Form
* Reopening Request
* Redetermination Forms

Page Last Updated: Thursday, 05-Apr-2012 12:32:19 CDT