How to Submit a Standard Reconsideration

Your appeal must first be reviewed by the DME MAC that initially processed your claim.  The first level of appeal is called a redetermination.  RiverTrust can only review your appeal after the redetermination has been completed.  The second level of review is 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)

NHIC Website: http://www.medicarenhic.com/

DME – Written Inquiries
P.O. Box 9146
Hingham, MA  02043-9146

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)

NGS website: www.ngsmedicare.com/

National Government Services, Inc.
P.O. Box 6036
Indianapolis, Indiana 46206-6036

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

Jurisdiction C – Cigna

Cigna Website: http://www.cignagovernmentservices.com/

CIGNA Government Services
P.O. Box 20009
Nashville, TN 37202

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)

Noridian Website: https://www.noridianmedicare.com/

NAS Marketing Department
Service Inquiry
901 40th Street South
Suite 1
Fargo, ND 58103

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.

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

Click here to download a standard reconsideration form. (pdf) (offsite)

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

• The beneficiary's name
• The beneficiary’s 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 patient or representative of the patient
• The name of the contractor that made the redetermination