Match the request to the actual claim decision
Find the specific service and date on the MSN and compare them with your appointment or billing records. Medicare directs beneficiaries to use the appeal date printed on that notice. CMS describes the first-level request period as 120 days from receipt of the initial determination.
If the problem appears to be a minor claim error or omission, ask the provider or contractor which correction process applies. CMS distinguishes corrections and reopenings from appeals. A conversation about correcting a claim does not itself document that an appeal was filed.
Sources: Medicare: appeals in Original Medicare; CMS: first-level redetermination by a Medicare contractor
Prepare the first-level written request
CMS permits Form CMS-20027 or a written request containing the required information. Identify the beneficiary, Medicare number, specific service, service date, person appealing and reason for disagreeing with the decision. The form also asks for a copy of the initial notice.
Write about the actual item under review and explain the disagreement accurately. Keep the notice beside the form so dates and service descriptions remain consistent. If you are unsure what a notice entry means, ask Medicare or the contractor to explain it before substituting your own interpretation.
Sources: CMS: first-level redetermination by a Medicare contractor; CMS-20027: first-level redetermination request form
Ask about evidence and any representative paperwork
Medicare suggests asking the provider for information that may help the appeal. Request relevant records or an explanation of the billed service through the provider’s process. Let the provider supply clinical information; this organizer does not determine whether a service should be covered.
CMS-20027 allows evidence to be attached or a statement describing what will be submitted and when. Additional evidence must arrive before the redetermination is issued. If another person is formally representing you, follow Medicare’s appointment-of-representative requirements rather than assuming a family relationship is sufficient.
Sources: Medicare: appeals in Original Medicare; CMS-20027: first-level redetermination request form; Medicare: appeal forms and representative appointment
Send it to the contractor and retain the result
Send the request to the Medicare Administrative Contractor that made the decision, using the address on the MSN and its current filing instructions. CMS notes that contractors may offer electronic submission. A generic CMS address or a later-level appeals form is not the same destination.
Keep the packet and dated confirmation together. Medicare explains that an allowed item may appear on a later MSN; an unfavorable result comes with a Medicare Redetermination Notice. Read the actual response for any further action. Preparing a complete request does not guarantee a payment or a particular outcome.
Sources: CMS: first-level redetermination by a Medicare contractor; Medicare: appeals in Original Medicare; Medicare: appeal forms and representative appointment
Your next-step checklist
- Locate the specific item, date and appeal deadline on the MSN.
- Ask whether a minor error needs correction rather than appeal.
- Prepare CMS-20027 or the required written request.
- Request relevant supporting information from the provider.
- Include representative documentation when applicable.
- Use the issuing contractor’s filing instructions and keep confirmation.
Keep personal, insurance and medical information in the appropriate organization’s approved secure channel.
Common questions
Is CMS-20033 the form for the first appeal?
No. Medicare lists CMS-20027 for redetermination, the first appeal, and CMS-20033 for reconsideration after that decision. Use the stage identified in your notice.
Sources: Medicare: appeal forms and representative appointment
Can I send additional evidence after filing CMS-20027?
The form permits it, but says the evidence must be received before the redetermination is issued. Describe outstanding evidence and its expected submission as instructed, and follow the contractor’s process.
Sources: CMS-20027: first-level redetermination request form
Sources and verification
The sources below support the administrative information in this guide. Follow the responsible organization’s current instructions when requirements, forms or contact routes change.