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Appeals

Welcome to the WPS Medicare Appeals web page.

Reopening Phone Number

(866) 234-7331
8:00 am to 5:00 pm ET

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. Departmental Appeals Board (DAB)/Appeals Council
  5. Judicial Review in Federal District Court

Appeals Information

Does Your Appeal Request Require Documentation?
Duplicate Appeal Requests
How to Appeal a Claim Determination
How to Request a Reopening
How to Submit Your Appeal Request by Fax
Medicare Appeals - The Importance of Getting It to the Right Place at the Right Time!
Overpayment Redeterminations and Recoupment
Unprocessable Claim Rejections Do Not Have Appeal Rights

CMS Resources

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

Calculators/Tools

Appeals Decision TreeMedia File
Redetermination Calculator
Reopening Calculator

Forms

Appeals and related forms are available by selecting Forms from the top navigation, then Appeals, including:

* Fax Form
* Reopening Request
* Redetermination Forms

Page Last Updated: Thursday, 20-Mar-2014 12:04:31 CDT