Case Re-Review Request Confirmation

This page confirms that you have successfully submitted a request for re-review of the Case Number displayed at the top of the page. The reason for your request, any additional notes submitted, and the names of any uploaded files will also display.

For Amended Reviews, the following information also displays:

• Re-Review Request Type
• Reason for Re-Review Request
• New Proposed MSA Amount
• Documentation uploaded
• New Case Submission Date
• Summary Medical Changes
  Updated medical details, if applicable, including a list of all selected line items and the option selected for each, freeform text associated to selected line items, and additional care lines added.
• Summary Prescription Changes
  Updated prescription drug details, if applicable, including existing drugs that have been edited or selected to be removed and drugs that have been added as part of the re-review request.

Click Print this Page to print a copy of this page for your records.

Click Continue to return to the Case Summary page.

Next Steps

When the Regional Office (RO) has made a determination on the Re-Review Request, they will complete the CMS Response section on the Re-Review Request form and you will receive an Alert (Approval Letter). The Approval Letter will include the completed Re-Review Request attachment with the RO determination. You will be able to view this attachment on the WCMSAP.