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Step 1 of 3Centers for Medicare & Medicaid Services · CMS-20027
CMS-20027 - Redetermination Request Form
CMS-20027 is used to request a redetermination (first-level Medicare appeal) for a claim decision.
Current step
Beneficiary and claim details
Beneficiary name, Medicare number, and Item or service you are appealing
This step
5 fields · 3 required
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Need more context?
The form is ready to fill now. If you want supporting instructions, mailing notes, or source links, they are below.
What you need+
- Beneficiary identifying information
- Claim item or service details
- Reason you disagree with the determination
- Appellant contact details and mailing address
- Signed form (wet signature required)
- Supporting appeal evidence (optional) (optional) — Attach claim notices, medical records, or other documentation supporting your redetermination request.
How it works+
- Fill out the form
- Add attachments
- Preview the PDF
- Mail it
Where it gets mailed+
Enter the recipient address during checkout.
Packet order+
- Cover sheet (auto-generated)
- Completed form PDF
- Attachments (in the order you upload)
FAQs+
Who should receive CMS-20027?
Send it to the Medicare Administrative Contractor identified on your Medicare Summary Notice or initial determination notice.
Can I include extra evidence?
Yes. You can attach records or documents that support your appeal.
Is this the first step in a Medicare appeal?
Yes. Redetermination is the first level of the Medicare claims appeal process.
Sources+
Last verified+
Last Centers for Medicare & Medicaid Services verification: March 21, 2026