Which Form Do I Use?

Do you need to submit a redetermination or a written reopening? Find resources, links and instructions to assist you with selecting the proper appeals form.

Find Railroad Medicare forms on our website. Answer simple questions to determine which form to use for your appeals scenario. 

Railroad Medicare appeals forms available on our Forms webpage include: 

• Redetermination: 1st Level Appeal 
  • This consolidated Redetermination form is used to request both timely and late submissions of non-overpayment appeals (initial claim denials and payments), overpayment appeals, and appeals of Comprehensive Error Rate Testing (CERT) decisions
• Reopening: Simple Claim Correction
•  Reopening: Simple Claim Correction — Late Submission

Railroad Medicare Appeals online forms available on the eServices portal include:

• Redetermination: 1st Level Appeal
• Redetermination: 1st Level Appeal — Late Submission
• Redetermination: Comprehensive Error Rate Testing (CERT)
• Redetermination: Comprehensive Error Rate Testing (CERT) — Late Submission
• Redetermination: Overpayment Appeal
• Redetermination: Overpayment Appeal — Late Submission
• Reopening: Simple Claim Correction
• Reopening: Simple Claim Correction — Late Submission