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Help Us Reduce Delays In Responding to You - Revised 12-18-06
Although the Centers for Medicare & Medicaid Services (CMS) allows 45 business days to process written inquiries and 60 calendar days to process redeterminations, the Upstate Medicare Division is always looking for ways of improving customer service by reducing the time it takes to respond to your written correspondence. There are steps you can take to further help reduce the time it takes to receive a response to your inquiry or redetermination request.
Use the Proper PO Boxes When Submitting Information to Medicare
Correspondence that is sent to a claims PO box will result in delays in processing, as we will need to take additional time to research the information sent in to determine if it is in fact an inquiry or redetermination request.
Please be sure to send only claims to the claims PO boxes, as indicated below. Please simply submit a new claim or corrected CMS-1500 claim form. We ask that you do not send in claims with a cover letter or write any messages on the claim forms, as this will result in similar delays.
- Assigned Claims - PO Box 5202.
- PAR Claims - Continue to use the unpublished PO box.
- Non-Assigned Claims - PO Box 600.
- Response to Request for Additional Information - PO Box 1100. When you are returning additional information that was requested during the initial claim processing, please be sure to include the request letter or a copy of the request letter to ensure that the information gets to the requestor.
If you are submitting a written request for general information, such as the status of a claim, duplicate remittance, claim, or check copies, Medicare forms, or information or explanations of coverage or guidelines, please send the request to PO Box 5302.
A written request for redetermination based on your appeal rights (see below) should be sent to PO Box 5200.
The following must be submitted with each redetermination request in order for it to be considered a complete and clear request for redetermination:
- Beneficiary Name.
- Health Insurance Claim Number.
- Specific Dates of Service in Question (ranges of dates are acceptable only if a range of dates is properly reportable on the Medicare claim form).
- Specific Items/Services in Question for Which the Redetermination is Being Requested.
- Name and Address of Provider.
- Signature of Appellant.
Form CMS-1964 can be used when all the requested information is completed. Please be sure that you have specified which items or services are in question and why. You can access the Provider Request for Redetermination form  on our Web site.
Reminder: Redeterminations must be requested within 120 days of the initial determination.
Failure to provide our office with the above information will result in the delay of your decision. Incomplete/unclear redetermination requests will be dismissed with a letter indicating what information was lacking to process the redetermination.
Please clearly indicate the type of correspondence on the outside of your envelope.
You can find all of our PO boxes and mailing information on our Web site.
We thank you for your anticipated cooperation in helping us to further reduce the time it takes for us to respond to you. |
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