What is a Medicare redetermination?
A redetermination is the first level of a Medicare Part A or B appeal, decided by the Medicare Administrative Contractor that processed the claim. It must be filed within 120 days.
Redetermination timeline
| Event | Date |
|---|---|
| Initial determination on the remittance | 03/20/2026 |
| Presumed received, 5 days later | 03/25/2026 |
| Redetermination deadline, 120 days after receipt | 07/23/2026 |
| Contractor's decision, usually within 60 days of filing | Varies |
- For an overpayment demand, the clock that matters is shorter: file within 30 days of the demand letter to keep Medicare from recouping while the appeal is decided.
Every Medicare Part A and B appeal starts here. The contractor that made the original decision reviews it again, with whatever new evidence the provider sends.
What to send
The redetermination request form or a letter with the same information, a clear statement of why the decision was wrong, and the records that prove it. For medical necessity denials, that means the notes and results that meet the LCD or NCD criteria the contractor applied.
Redetermination and recoupment
When Medicare demands repayment of an overpayment, it starts taking the money from future payments, a recoupment, if the demand isn’t paid or appealed. Filing a redetermination within 30 days of the demand letter delays recoupment until the appeal is decided.
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