Appeals for cancelled claims related to Medicare beneficiaries classified as “unlawfully present” in the U.S.

In some cases, claims submitted for beneficiaries determined to be unlawfully present in the United States were reprocessed without offering appeal rights on the resulting overpayments. New Informational Unsolicited Response (IUR) Process to Identify Previously Paid Claims for Services Furnished to Medicare Beneficiaries Classified as “Unlawfully Present” in the United States.” In addition, in some cases where appeal rights were offered on the reprocessed claims, appeals were not processed appropriately. Providers and suppliers are entitled to file appeals for these reprocessed claims, and appeals should be processed on these claims even if appeal rights were not initially offered. Providers and suppliers are entitled to submit a request for redetermination within 120 calendar days from the later of either (a) the date of receipt of the remittance advice indicating recovery of payment for such services, or (b) April 1, 2014. In cases where a request for redetermination of such services was refused, providers and suppliers are entitled to resubmit their request within 120 calendar days from the later of either (a) the date of receipt of the letter or notice from their Medicare administrative contractor (MAC) refusing to process the appeal, or (b) April 1, 2014. If the request for redetermination of such services resulted in a dismissal notice from their MAC, providers and suppliers may request that the dismissal be vacated. Requests to vacate the dismissal must be filed with their MAC within six months of the later of (a) the date of receipt of the dismissal notice, or (b) April 1, 2014, provided a request for review of the dismissal was not filed with the qualified independent contractor (QIC). Any requests pending before the QIC will be processed by the QIC. In cases where a redetermination request for such services was processed by their MAC, providers and suppliers are entitled to request a reopening of the redetermination decision within the later of either (a) one year of the date of receipt of the redetermination notice, or (b) October 1, 2014, if they disagree with the redetermination decision, provided a request for reconsideration has not been filed with the QIC. Any requests pending before the QIC will be processed by the QIC. For any appeal request, request to reopen an appeal decision, or a request to vacate a dismissal where the original claim was cancelled, providers must submit a paper claim that replicates the original cancelled claim with their appeal or reopening request. Failure to submit a paper claim with the appeal or reopening request will result in delays in effectuating favorable appeal decisions.