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Appeals

Appeal Level Time Limit for Filing Request Form
Reopening One year from initial determination date or after one year from receipt date due to overpayment via clerical error omissions Reopening [PDF]
Redetermination (First Level) 120 days from initial determination receipt date Redeterminations - Signature Required [PDF]
Reconsideration (Second Level) 180 days from Redetermination receipt date CMS 20033 – Medicare Reconsideration Request This link takes you to an external website.
Administrative Law Judge (ALJ) (Third Level) 60 days from Reconsideration receipt date OMHA-100 & OMHA-100A Forms - Request for Medicare Hearing by an ALJ This link takes you to an external website.
Medicare Appeals Council (Departmental Appeals Board (DAB)) (Fourth Level) 60 days from ALJ hearing decision receipt date Appeal Form DAB-101 This link takes you to an external website.
Federal Court Review (Fifth Level) 60 days from receipt date of DAB decision or review declination Refer to DAB decision

 

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Last Updated Oct 18, 2017