Cahaba Redetermination Smart Form

Cahaba’s Medicare Appeals department has seen an increase in providers downloading or copying the Appeals Smart Form to submit their appeal request. As information is entered on the Smart Form, the bar code is manipulated with information specific to that patient and appeal. Please note, when smart forms are downloaded or copied, the bar code does not change on the form, and as a result, the incorrect patient/claim information is submitted. Please access the form from Cahaba’s website each time an appeal needs to be submitted. Providers should complete the form online, print it, sign the form and fax/mail to Cahaba. The preferred method to submit an appeal request is through our InSite portal.

Source: https://www.cahabagba.com/part-b/claims-2/appeals-2-2/