CMS Upgrades the WCMSAP to accept Reconsiderations

CMS Upgrades the WCMSAP to accept Reconsiderations

CMS has released instructions on how to submit a case for re-review.

Beginning immediately, you can use the WCMSAP tool to request CMS re-review case if you disagree with the Regional Office’s decision. A WCMSAP case is eligible for re-review when it is in approved status and a re-review has not already been requested.

The released changes to the submission process not only simplifies the process but ensures that a re-review will occur. In the past, the review of a “reconsideration request” was based on the individual Regional Offices discretion – based on their current

A re-review can be submitted based on the following:

  1. If the CMS’s determination contains obvious mistakes
  2. Additional evidence, not previously considered by Medicare and is dated prior to the CMS Approval letter will affect the CMS determination

Click here to review the CMS user guide of the new WCMSAP functionality.

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