You must complete the Medicare Redetermination Request form if you’re appealing a claim denial by Medicare for the first time. This leads to the first phase of the Medicare appeals process.

A person unsatisfied with Medicare's decision on a coverage claim may fill out the Medicare redetermination form to request a review of the original claim decision.

You can use the Medicare Reconsideration Request form or send a letter to the address shown on your Medicare redetermination notice.

A person unsatisfied with Medicare's decision on a coverage claim may fill out the Medicare redetermination form to request a review of the original claim decision.

You must complete the Medicare Redetermination Request form if you’re appealing a claim denial by Medicare for the first time. This leads to the first phase of the Medicare appeals process.