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Providers in AR, CO, LA, MS, NM, OK, TX, Indian Health & Veteran Affairs

Appeals Status Inquiry Tool for First Level

Been here before? Proceed with Your Appeals Status Inquiry now.

Introduction

This tool provides status of receipt of a first level appeal (redetermination) request and allows you to view if the appeal is under review or finalized. This tool will not allow you to view the decision of the appeal or allow you to view any individual patient details.

Each response will include the following information:

Date the case was received
Case Control Number (CCN)
Status of case – pending or finalized
Closed date of case if finalized
Claim number for claim in question

Instructions

Click here to open the Appeals Status Inquiry tool in a new browser tab or window.

Once you have entered your search criteria, click on "Submit Query".

Search Criteria that can be used:

Select the Medicare Plan (Part A or Part B).
Select the state in which the services were rendered.
Value field narrow your search by:
Correspondence Control Number (CCN)
Provider Transaction Access Number (PTAN)
PTAN and the Internal Control Number (ICN)
PTAN and Document Control Number (DCN)

Once the query is submitted, you will receive a screen similar to this:

Field Definitions

CCN - The number assigned to the appeal request, found on your decision letter.
PTAN - The number assigned by the Medicare Administrative Contractor (MAC) that is used to process claims.
DCN - The Part A claim number assigned during the initial processing found on your remittance statement or voiced in the Interactive Voice Response (IVR) unit.
ICN - The Part B claim number assigned during initial processing, found on your remittance statement or voiced in the IVR.

Redeterminations will be completed within 60 days of receipt of the request unless additional documentation is submitted by the provider/supplier and received prior to issuance of the dismissal and/or decision notice.

Questions regarding appeal status requests other than a redetermination should be directed to the party that is reviewing the documentation depending on the level of appeal (i.e. for a second level of appeal C2C Innovative Solutions – QIC would need contacted).

Note: This warning provides privacy and security notices consistent with applicable federal laws, directives, and other federal guidance for accessing this Government system, which includes all devices/storage media attached to this system. This system is provided for Government authorized use only. Unauthorized or improper use of this system is prohibited and may result in disciplinary action and/or civil and criminal penalties. At any time, and for any lawful Government purpose, the government may monitor, record, and audit your system usage and/or intercept, search and seize any communication or data transiting or stored on this system. Therefore, you have no reasonable expectation of privacy. Any communication or data transiting or stored on this system may be disclosed or used for any lawful Government purpose.


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Last modified:  11/17/2017