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The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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Levels of Appeals and Time Limits for Filing

Time Limits for Each Level of Appeal

The time limits for filing appeals vary according to the type of appeal:

    • Redetermination - The time limit for filing a request for redetermination is 120 days from the date of receipt of the Medicare Summary Notice (MSN) or Remittance Advice (RA).
    • QIC Reconsideration - The time limit for filing a request for reconsideration is 180 days from the date of receipt of the notice of the redetermination. If a party requests QIC review of a MAC’s dismissal of a request for redetermination, the time limit for filing is 60 days from the date of receipt of the MAC’s dismissal notice.
    • ALJ Hearing - The time limit for filing a request for an ALJ hearing is 60 days from the date of receipt of the reconsideration notice.
    • Appeals Council Review - The time limit for filing a request for review by the Appeals Council is 60 days from the date of receipt of the ALJ’s decision.
    • Judicial Review - The time limit for filing for judicial review is 60 days from the date of the Appeals Council's decision.

When the filing deadline for a redetermination ends on a Saturday, Sunday, legal holiday, or any other nonwork day, the MAC shall apply a rollover period that extends the filing deadline to the first working day after the Saturday, Sunday, legal holiday, or other nonwork day. For example, if the filing deadline for a redetermination falls on the Saturday before Columbus Day, the filing deadline is extended to the first working day after the Columbus Day holiday.

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