General Appeals Process in Initial Determinations (Implementation Dates for FI Initial Determinations Issued on or After May 1, 2005, and Carrier Initial Determinations Issued on or After January 1, 2006).
The Medicare claim appeals process was amended by the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 BIPA). Section 1869(c) of the Social Security Act (the Act), as amended by BIPA, requires a new second level in the administrative appeals process called a reconsideration. This new reconsideration is different from the previous first level of appeal for Part A claims performed by FIs. Reconsiderations will be processed by qualified independent contractors.
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: October 07, 2005
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