There are Five levels of Appeals:
1st Level – Determination
MAC reviews the documents of initial claim determination. You have 120 days after you receive initial determination. The action decision takes 60 days.
2nd Level – Redetermination
QIC reviews – Document review of redetermination (you should submit any evidence not previously presented at this level). You must request an appeal 180 days after you receive MRN/RA. You will get an action decision within 60 days.
3rd Level – ALJ Hearing
ALJ reviews – May be an on-the-record review or an interactive hearing between parties. You just request an appeal up to 60 days after you receive notice of QIC decision or after expiration of the applicable QIC reconsideration timeframe if you do not receive a decison. The action decision is based on volume.
4th Level – Medicare Appeals Council Review
Appeals Council reviews – Document review of ALJ’s decision or dismissal (but you may request oral arguments). You must request an appeal up to 60 days after you receive notice of ALJ’s decision or after expiration of the applicable ALJ hearing timeframe if you do not receive a decision. You should get a decision in 90 days if appealing an ALJ decision or 180 days if ALF review time expired without an ALJ decision.
5th Level Judicial Review – The U.S. District Court will review your decision. You must appeal up to 60 days after you receive notice of appeals council decision or after expiration of the applicable appeals council review timeframe if you do not receive a decision. There is no statutory time limit for a decision.
Medicare revocation appeals