Submitting Unified Program Integrity Contractor (UPIC) Overpayment Redetermination Requests

Appealing a Unified Program Integrity Contractors (UPIC) Decision/Overpayment

When requesting a redetermination of a UPIC decision, it is important to send in all appropriate information with your appeal request.

Be sure to provide

• Any additional supporting documentation not reviewed at the UPIC level
• A completed Appointment of Representative (AOR) form or to include all the required AOR elements, when designating someone else to represent you on the appeal 
• A valid phone number and extension for the person requesting the appeal

If you would like to request a redetermination for the entire UPIC decision, only one redetermination request form is needed. You can submit the form with the spreadsheet received from the UPIC. If appealing all items on the spreadsheet, please state all. If you are not appealing all items on the spreadsheet, please clearly indicate (circle or asterisk) which services you are asking us to review.  

More information on the Appointment of Representative (AOR) can be found in the CMS Internet-Only Manual (IOM), Publication 100-04, Chapter 29 (PDF), Section 270.1.2. 

• CMS1696: Appointment of Representative (PDF)
• Medicare Claims Processing Manual (PDF)