42 CFR §405.944

1. (a)Filing location. The request for redetermination must be filed with the contractor indicated on the notice of initial determination.
2. (b)Content of redetermination request. The request for redetermination must be in writing and should be made on a standard CMS form. A written request that is not made on a standard CMS form is accepted if it contains the same required elements as follows:
   1. (1)The beneficiary's name;
   2. (2)The Medicare number;
   3. (3)Specific service(s) and/or item(s) for which the redetermination is being requested and the specific date(s) of the service;
   4. (4)The name of the party or the representative of the party.
3. (c)Requests for redetermination by more than one party. If more than one party timely files a request for redetermination on the same claim before a redetermination is made on the first timely filed request, the contractor must consolidate the separate requests into one proceeding and issue one redetermination.