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 | Redetermination [PDF] |
| Reconsideration (Second Level) | 180 days from Redetermination receipt date | |
| Administrative Law Judge (ALJ) Hearing (Third Level) | 60 days from Reconsideration receipt date | |
| Medicare Appeals Council Review (Departmental Appeals Board (DAB)) (Fourth Level) | 60 days from ALJ hearing decision receipt date | |
| Federal Court Review (Fifth Level) | 60 days from receipt date of DAB decision or review declination | Refer to DAB decision |
Resources
- CMS Medicare Learning Network (MLN) Matters Special Edition (SE)1426
- CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 29 – Appeals of Claims Decisions
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 34 – Reopening and Revision of Claim Determinations and Decisions
Last Updated Apr 13, 2017