Timeliness

Published 03/02/2021

Provider, beneficiaries, and suppliers all have the right to appeal the an initial claim decision. There are five levels of appeals, and each has a different time limit for filing. Here you can find information to determine the timeliness of your appeal.

Appeals Time Limit
Redetermination (initial appeal) 120 days from the date of receipt of the initial claim determination notice. The notice of initial determination is presumed to be received 5 days from the date of the notice.
Reconsideration -
Qualified Independent Contractor (QIC)
180 days from receipt of the redetermination
Administrative Law Judge (ALJ) 60 days from receipt of the QIC decision
Departmental Appeals Board Review (DAB)/Appeals Council 60 days from the date of the ALJ decision or dismissal
Federal District Court Review 60 days from the date of the Appeals Council decision