Requesting a Part A Reconsideration from a Level 1 Appeal (Redetermination)
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Requesting a Part A Reconsideration from a Level 1 Appeal (Redetermination)
You currently have jurisdiction selected, however this page only applies to these jurisdiction(s): .
The following types of redeterminations are not available for a reconsideration through the WPS Government Health Administrators Portal:
- Favorable redetermination.
- Closed as misrouted
- Any claim that has not had a completed Level 1 Appeal done on it.
Steps for Submitting a Part A Reconsideration via the Message Center from a Level 1 Appeal
Once you confirm your Level 1 Appeal fits the criteria for a Reconsideration:
Step 1: Locate the Part A redetermination by using the below search criteria:
Step 2: Once the Redetermination is found, click on the Tracking Number link to go to the Level 1 appeal.
Step 3: Click on the Submit Reconsideration button to bring up the form.
The Registrant name, Email address, Service Location (NPI), Category, and Sub Category will auto-populate.
Step 4: If you are appealing certain claim line items, place a check mark next to the lines you are appealing.
Step 5: Indicate why you disagree with Medicare’s initial claim determination. You can also provide additional information you want Medicare to consider when making the reconsideration.
NOTE: If you are submitting your reconsideration late (i.e., more than 180 days after the initial determination), the portal will alert you that your appeal is late. It will also provide an additional field where you can indicate your reason for filing a late appeal. You will only see this additional field if it has been more than 180 days since the initial redetermination.
Step 6: Provide your contact information. Note that your name will be prepopulated from your portal account.
Step 7: If you have documentation to submit, click the Upload Files button to upload it from your computer. The file size cannot exceed 100 MB (102,400 KB) for Part A appeals. The portal accepts the following document types:
- .docx
- .xlsx
- .jpg
- .jpeg
- .gif
- .tif
- .tiff
- .zip
If you have multiple documents to submit (up to 20 files), place them all in a single .zip file. Remember to disable all password protection, macros, and external links before submitting the documentation.
Step 8: Review the disclosure statement and indicate if you agree to the terms. If you agree, click the Review button to have the portal check your appeal for missing items. You can click the Clear button to clear the information on the form or the Cancel button to exit the appeal without submitting it.
Step 9: Once the portal reviews your appeal for missing items, click the Submit button to submit your reconsideration, or click the Cancel button to make changes before submitting it.
NOTE: You cannot make any changes to your appeal once you submit it.
Steps for Submitting a Part A Reconsideration via the Appeal Search Link
A Part A reconsiderations can also be submitted by going through the Appeal Search function when checking the status of an appeal. Access Appeal Search by clicking on the link at the bottom of the left navigation menu.
Step 1: Once on the Appeal Search screen, select the Part A/Part B Appeal tab and enter the following details about the claim you appealed:
- Patient’s Medicare number
- Patient’s first initial and last name
- Date of service
Depending on the service locations you have access to, the fields on the Part A/Part B Appeal tab may appear slightly differently than the screen below.
Step 2: Click the Search button to search for the claim(s) meeting the selected criteria. The results appear on the Appeal Results page. Note that the portal displays Part A and Part B results differently.
Step 3: Click on the View Decision link and you will be taken to the Appeal Decision.
Step 4: Click on the Submit Reconsideration button to bring up the Reconsideration form. You will also find a link to a copy of the Decision letter.
The Registrant name, Email address, Service Location (NPI), Category, and Sub Category will auto-populate.
Step 5: If you are appealing certain claim line items, place a check mark next to the lines you are appealing.
Step 6: Indicate why you disagree with Medicare’s initial claim determination. You can also provide additional information you want Medicare to consider when making the reconsideration.
NOTE: If you are submitting your reconsideration late (i.e., more than 180 days after the initial determination), the portal will alert you that your appeal is late. It will also provide an additional field where you can indicate your reason for filing a late appeal. You will only see this additional field if it has been more than 180 days since the initial redetermination.
Step 7: Provide your contact information. Note that your name will be prepopulated from your portal account.
Step 8: If you do have documentation to submit, click the Upload Files button to upload it from your computer. The file size cannot exceed 100 MB (102,400 KB) for Part A appeals. The portal accepts the following document types:
- .docx
- .xlsx
- .jpg
- .jpeg
- .gif
- .tif
- .tiff
- .zip
If you have multiple documents to submit (up to 20 files), place them all in a single .zip file. Remember to disable all password protection, macros, and external links before submitting the documentation.
Step 9: Review the disclosure statement and indicate if you agree to the terms. If you agree, click the Review button to have the portal check your appeal for missing items. You can click the Clear button to clear the information on the form or the Cancel button to exit the appeal without submitting it.
Step 10: Once portal reviews your appeal for missing items, click the Submit button to submit your reconsideration or click the Cancel button to make changes before submitting it.
NOTE: You cannot make any changes to your appeal once you submit it.
Steps for Submitting Additional Documentation for a Part A Reconsideration via the Message Center
Step 1: Locate the Part A reconsideration by using the below search criteria:
Step 2: Once the Reconsideration is found, click on the Tracking Number link to go to bring up the Reconsideration.
Step 3: The reconsideration will display, and you will need to scroll to the bottom of the page and click the Attach Additional Documentation button.
Step 4: To upload your additional documentation, click on the Upload Files bar to locate your files on your computer. The file size cannot exceed 100 MB (102,400 KB) for Part A appeals. The portal accepts the following document types:
- .docx
- .xlsx
- .jpg
- .jpeg
- .gif
- .tif
- .tiff
- .zip
Step 5: Once your Files have been uploaded, they will display for your verification. Once all new files have been uploaded click the Submit Additional Documentation button.
Step 6: You will receive a message that the documents have been successfully attached.
global-tags: J8A,J5A,J8B,J5B
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