RiverTrust

Q: What is a reconsideration?

A reconsideration is the second level in the revised Medicare appeals process. An appellant may file a request for reconsideration if he or she is dissatisfied with the results of the Medicare contractor's redetermination. RiverTrust reviews reconsiderations for Durable Medical Equipment Medicare Administrative Contractors (DME MACs).

Q: Where can I find a reconsideration form?

Click here to download a standard reconsideration form.

Q: Can I just send an appeal to RiverTrust and not go through the first step of review?

Your appeal must first be reviewed by the DME MAC that initially processed your claim. The first level of appeal is call a redetermination. RiverTrust can only review your appeal after the redetermination has been completed. The second level of review is called a reconsideration. Please see the contact information from your Medicare Summary Notice to identify the DME MAC that processed your claim. Below is the list of the jurisdictions by contractor name and the states assigned to them.

Jurisdiction A - National Heritage Insurance Company (NHIC)

The states included in DME MAC Jurisdiction A are: Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont

Jurisdiction B - National Government Services (NGS)

The states included in DME MAC Jurisdiction B are: Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin.

Jurisdiction C – Cigna

The states included in Jurisdiction C are: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, and West Virginia.

Jurisdiction D - Noridian Administrative Services (NAS)

The states included in DME MAC Jurisdiction D are: Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, and Wyoming.

Q: Do I need to use the standard reconsideration form or can I simply submit the request in writing?

The standard reconsideration form includes all information necessary to submit a request. However, use of the form is optional.

Q: What should I include on the reconsideration request?

If you do not complete the standard reconsideration form, your written request should include the following information:

The beneficiary's name; Medicare health insurance claim number;
The specific service(s) and item(s) for which the reconsideration is requested and the specific date(s) of service;
The name and signature of the party or representative of the party;
The name of the contractor that made the redetermination

Q: How will I know that RiverTrust has received my reconsideration request?

RiverTrust has 14 days to acknowledge your reconsideration request by letter. Please allow 14 days to hear back from us.

Q: I submitted a reconsideration request and have not heard anything. What should I do?

If more than 14 days have passed and you have not received a response from RiverTrust, you may send a letter to us. Be sure you are writing to the correct QIC, RiverTrust handles reconsiderations for Durable Medical Equipment appeals.

Q: I’ve received an acknowledgement letter from RiverTrust. How do I check the status of my reconsideration? Do I need a login to view the status of an appeal?

Beneficiary

You can call 1-800-Medicare (1-800-633-4227) to check the status of the reconsideration.

Provider

You may check the status of the reconsideration request by going to the “Providers: Appeal Status Information” section of www.Q2A.com . Enter the reconsideration Medicare Appeal Number in the search field.

Search results only include the following basic information about an appeal: date received, appeal status, and deadline. Privacy laws prohibit the display of any protected health information (PHI).

A Provider does not need a login to view the status of an appeal. All information for providers is located on the public side of the Q2A.com Web site.

Q: Where can I find my reconsideration appeal number?

You will find the reconsideration appeal number in the upper right-hand corner of the acknowledgement letter sent by the QIC handling your case.

Q: How long does it take RiverTrust to make its decision?

RiverTust has 60 days to make a decision. If we cannot complete the reconsideration within that time frame, you have the opportunity to escalate the request to an Administrative Law Judge (ALJ) hearing.

Q: I am a beneficiary and I have a question about my reconsideration. How do I get in touch with someone regarding my appeal?

If you are a beneficiary, call 1-800-MEDICARE for any questions regarding an appeal.

Q: I am a provider and I have a question about my reconsideration. How do I get in touch with someone regarding my appeal?

If you are a provider, you may submit a written inquiry to RiverTrust or call us at (423) 535-4386.

Providers can go to www.Q2A.com and click on the link “Providers: Appeal Status Information” . Any specific questions should be addressed in a written inquiry to RiverTrust.

Q: How can I contact RiverTrust?

Contact information is located on your acknowledgement letter. If you have not received an acknowledgement letter, please write us at the address below:

RiverTrust Solutions, Inc.
PO Box 180208
Chattanooga, TN 37401-7208