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Criteria: , Region: |
Change Criteria |
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Filing an Appeal
The following chart lists the various levels of appeals available, including time limitations for filing and, where applicable, the minimum amount in controversy requirement. Note: If a decision was not issued at a previous level, appeals to higher levels will usually be dismissed back to the appropriate prior level for review.
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Redetermination |
Reconsideration (qualified independent contractor (QIC) |
Administrative law judge (ALJ) |
Medicare Appeals Council (MAC) |
Federal court review |
Time Limit for Filing |
120 days from date of receipt of the notice initial determination |
180 days from date of receipt of the redetermination |
60 days from the date of receipt of the reconsideration |
60 days from the date of receipt of the ALJ hearing decision |
60 days from date of receipt of MAC decision or declination of review by MAC |
Amount in Controversy (monetary threshold to be met) |
No minimum (none) |
No minimum (none) |
Prior to January 1, 2006, at least $100 remains in controversy. From January 1, 2006 to December 31, 2007, at least $110 remains in controversy. For requests filed on or after January 1, 2008, at least $120 remains in controversy. |
No minimum (none) |
For requests filed on or after January 1, 2007 to December 31, 2007, at least $1,130 remains in controversy. For requests filed on or after January 1, 2008, at least $1180 remains in controversy. |
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Untitled Page
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Untitled Page
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