DME - Signature Required on Redetermination Requests
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DME - Signature Required on Redetermination Requests

Effective July 1, 2007, redetermination requests submitted without the signature of the requesting party will be processed as an incomplete request and dismissed.

The following information is required when submitting a redetermination request:

  • Beneficiary name
  • Medicare Health Insurance Claim (HIC) number of the beneficiary.
  • Specific service(s) and/or item(s) for which the redetermination is being requested, i.e., HCPCS.
  • Correct dates of service, including all from and through dates from the remittance advice.
  • Name and signature of the party, or representative of the party, requesting the redetermination.
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