Frequently Asked Questions - Appeals

Home Provider Part B FAQs Appeals

All FAQs are current as of the date noted next to the question.

  1. What is a reopening? (06/20/06)

  2. Where can I find the redetermination form? (09/25/06)


  3. I recently received a denial from WPS Medicare for services I provided to a Medicare beneficiary. Subsequently, I filed a Medicare Redetermination Request form with WPS Medicare appealing the denial. Could you please tell me how long WPS Medicare has to respond to our appeal? (07/02/07)


  4. I have a service that I need to correct by increasing the quantity and the billed amount. How can I make that correction? (08/20/07)


  5. Does Medicare Part B have an Offset Request Form that providers can use to initiate a request for immediate offset of an overpayment? (09/10/07)




1. What is a reopening?
  decorative bullet A reopening is an alternative to the appeals process where minor errors or omissions in filing claims have occurred. For more information regarding the appeals process, visit our website.
Posted 06/20/06
Revised NA
 
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2. Where can I find the redetermination form?
  decorative bullet The redermindation form, along with additional information, is located on WPS' site by:
clicking here

CMS also has this form available at:
http://www.cms.hhs.gov/cmsforms/downloads/cms20027.pdf adobe portable format 23KB
Posted 09/25/06
Revised NA
 
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3. I recently received a denial from WPS Medicare for services I provided to a Medicare beneficiary. Subsequently, I filed a Medicare Redetermination Request form with WPS Medicare appealing the denial. Could you please tell me how long WPS Medicare has to respond to our appeal?
  decorative bullet The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual, Publication 100-4, Chapter 29, Section 60.11.4, explains that Medicare carriers must complete 95 percent of redetermination requests within 45 days of the receipt of the request. The date of receipt for purposes of this standard is defined as the date the request for redetermination is received in the corporate mailroom for written requests and as the date the request was received on the telephone for telephone requests. Carriers must complete all redetermination requests within 60 days of receipt of the request.

To view a copy of this publication, please refer to the CMS Website below:
http://www.cms.hhs.gov/manuals/downloads/clm104c29.pdf adobe portable format

Additional information on the appeals process, appropriate forms, and mailing addresses are available on the WPS Medicare Website.
Posted 07/02/07
Revised NA
 
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4. I have a service that I need to correct by increasing the quantity and the billed amount. How can I make that correction?
  decorative bullet That correction can be made by completing a CMS-20027 Medicare Redetermination Request Form. Attach any documentation that you believe is relevant.
Posted 08/20/07
Revised NA
 
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5. Does Medicare Part B have an Offset Request Form that providers can use to initiate a request for immediate offset of an overpayment?
  decorative bulletYes, Medicare now offers a Immediate Offset form. (Link Below) Instructions for Immediate offsets can be found on the form or under the Financial Department tab.

Immediate Offset Request Form adobe portable format
Posted 09/10/07
Revised 03/02/09
 
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Page Last Updated: Thursday, 04-Mar-2010 10:02:11 CST