New Part B Medicare redetermination and clerical error reopening request form

First Coast implemented a new and improved Part B Redetermination and Clerical Error Reopening Request Form to simplify your submission and help us better understand the intent of your appeal. We streamlined to one page and added new questions and fields such as:   

• Does your appeal involve the Recovery Auditor Decision?
• Does your appeal involve a 935 overpayment decision?
  • Tip: 935 information is located in the "Re:" section of the initial demand letter right above the provider's name, provider number, and outstanding balance
• Added a drop-down field to choose the category which your request pertains to:
  • Procedure Codes 00100-69999
  • Procedure Codes 70000-89999
  • Chiropractic Services
  • Procedure code beginning with “J” or “G” or 90000-99999 or Ambulance Service
  • Other

Other enhancements: 

• You no longer have to include a copy of your remittance advice notice
• Moved the provider information from the middle of the form to the bottom
• Simplified the reasons you need to provide us regarding your redetermination or clerical error reopening request to one field 

Want to learn more? Access our tutorial 

Access our new tutorial which provides step-by-step instructions on completing our Part B Redetermination and Clerical Error Reopening Request Form to ensure more accurate processing. 

Please start using the form immediately and make sure to destroy any copies of the old form. As always, don’t forget to include any documentation to support your case along with your redetermination request.