Redeterminations Status Update & Frequently Asked Questions
Why are the Customer Service Representatives (CSRs) unable to tell me whether my redetermination request has been received?
The internal method used by WPS Medicare to process redetermination requests may be a change from the method used by your outgoing contractor. Our process is as follows:
Each redetermination request is immediately assigned a tracking number upon receipt in the WPS mailroom. The tracking number includes the date of the receipt. The specific details of the request, such as the provider number, date of service, and patient's Medicare number, are not entered into the Multi-Carrier System (MCS) until a member of the Appeals staff works the request. Therefore, CSRs (and reopening staff) are unable to confirm receipt of redetermination requests prior to the time the case is worked.
Please note: If you have questions regarding a redetermination decision, please call Customer Service.
What should I do if I have not received a response to my request and we are approaching the timely filing deadline?
If you have not received a notice of the redetermination decision within 110 days from the original determination, you may want to resubmit your request. The request is considered timely if it is received in our mailroom by the 120th day.
The timely filing deadline for the first level of appeal or the redetermination request is 120 days from the date of the initial determination (remittance or process date). The "timely filing" deadline for the second level of appeal or the reconsideration is 180 days from the date of the redetermination decision.
For example, if the initial process date is January 25, 2008, you have 120 days, or until May 29, 2008, to file the redetermination request. If the redetermination decision date is June 25, 2008, you have 180 days from June 25, 2008 to file the next level of appeal.
What date are the requests currently being worked?
We do have some inventory that is aged more than 60 days. At this time you can expect the redetermination requests to be processed within 90 to 100 days. We would request that providers wait at least 110 days from the date of the initial determination before resubmitting a redetermination request.
Page Last Updated: Monday, 07-Jul-2008 13:44:22 CDT
