“Disqualified”: The Redetermination Appeal Process (Level 1)

Answer Summary:

If your response to the Disqualification Notice is rejected, you will receive a formal “Determination of Disqualification.” Do not panic. You have the right to file a Level 1 Redetermination Appeal. This is a formal legal request to have a different auditor review your file. The key to winning is to prove that the disqualification was based on a “Clerical Error” or a misinterpretation of the data, rather than a true deficiency.

Introduction:

You fought the notice. You lost.

Now you have the official Determination Letter. It says: “You are ineligible for the 2026 Round.”

Most providers quit here.

Do not quit.

The auditors are human (or algorithms). They make mistakes. You have one last shot before the contracts are awarded: The Level 1 Appeal.

The “Redetermination” Timeline

• Window: You typically have 30 days from the date of the letter to file.
• Method: Submitted via Connexion.

The “Clerical Error” Argument

Appeals are rarely won on “Mercy.” They are won on “Facts.”

• Winning Argument: “The auditor stated we missed the Ohio license. We uploaded the Ohio license on Page 4 of the PDF named ‘Licenses.pdf’. The auditor overlooked this valid document. See screenshot.”
• Losing Argument: “We forgot to upload the Ohio license, but here it is now.” (New data is not allowed).

Preserving Your Rights

Even if you lose Level 1, filing it preserves your right to go to Level 2 (Reconsideration) and Level 3 (ALJ). If you skip Level 1, you waive all future rights. Always file.

WWS Value Proposition: We Draft the Appeal

Wonder Worth Solutions treats this like a court case. We draft the legal argument, cite the specific page numbers of your original bid, and compel the auditor to reverse the decision.