For Appeals, providers will receive automated faxes with immediate notification of case determinations within 30 minutes of Acentra Health notifying the beneficiary or their family. Determination letters will be faxed to the number used for the medical record request. Telephone notification will be made to Medicare beneficiaries, acute care providers, and associated Medicare health plans with a hospital discharge appeals. Visit our appeals web page for more details, including some important reminders.

For HWDRG reviews, denial determination letters will be sent via fax to the QIO Liaison listed in the CMS Program Resource System (PRS). No letter is sent if the claim is fully approved upon first review.

Important: Ensure only one beneficiary’s medical record is uploaded per Case ID to protect privacy and maintain data security.