CMS-20027 Medicare Redetermination Request form – 1st level of appeal

Medicare Form Summary

You’ll need the CMS-20027 form if Medicare does not pay for a service or medical item and you’d like to appeal that decision.

What you’ll need:

• Basic information
• Medicare number
• Date the service or item was received
• Statement about why you do not agree with Medicare’s decision to not cover the service or item
• Any evidence to support your claim, including information provided by your doctor

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