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After submitting a redetermination request successfully on the MSPRP or by mail, you can view a read-only version of that request on the View Submitted Redeterminations page.
View Submitted Redeterminations Fields
| Field | Description |
| Case ID | The Case ID associated with the redetermination submission. |
| TOS | This field only appears for beneficiaries and users who signed in with multi-factor authentication. A two-digit identifier that represents the type of service received for the line item on the claim. It can be any of the following: 10 - Home Health Agency 20 - Skilled Nursing Facility (SNF) Non-swing 30 - SNF Swing 40 - Outpatient 41 - Outpatient Full Encounter 42 - Outpatient Abbreviated Encounter 50 - Hospice 60 - Inpatient 61 - Inpatient Full Encounter 62 - Inpatient Abbreviated Encounter 71 - Carrier 72 - Carrier Durable Medical Equipment Prosthetics/Orthotics & Supplies (DMEPOS) Claim 73 - Carrier Full Encounter Claim 81 - Durable Medical Equipment Regional Carriers (DMERC) Non-DMEPOS 82 - DMERC DMEPOS |
| Claim Control ID (ICN) | (Part B claims only) Claim Number (Internal Control Number) assigned to the claim by the Medicare processing contractor. |
| Line # | (Part B claims only) This number indicates one or more services that were billed on a single claim per Date of Service. |
| Redeterm. Reason | Reason submitted on the MSPRP for requesting a redetermination of this claim. |
| Redeterm. Received | Method of submission (MSPRP or Mail/Fax) and date the redetermination request was received. Note: Date appears only for redeterminations submitted on the MSPRP. |
| Total Charges | Amount billed by the provider. |
| Reimbursement Amount | Amount Medicare paid the provider. |
| Conditional Payment Amount | Amount due Medicare. |
| Notes submitted with the redetermination request(s): | If notes were submitted on the MSPRP with the redetermination request(s), this table appears. |
| Date Received | Date note was received. |
| Note Text | Free form text submitted with the redetermination request. |
| Documents submitted with the redetermination request(s): | If any documents were submitted on the MSPRP with the redetermination request(s), this table appears. |
| Date Received | Date document was received. |
| Document Name | Name of documents submitted with the redetermination request. |
If you need to submit any additional documentation for this request, it must be mailed to one of the following addresses:
For Benefits Coordination & Recovery Center (BCRC) cases:
MSPRP
P.O. Box 138892
Oklahoma City, OK 73113
For Commercial Repayment Center (CRC) cases:
Commercial Repayment Center (CRC) - NGHP
P.O. Box 1610
Lathrop, CA 95330
Click Continue to return to the Case Information page.
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January 2025
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