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Last Modified: 12/31/2020 Location: FL, PR, USVI Business: Part A, Part B

Need status on an appeal?

Use the appeals status lookup tool to determine if First Coast has received your appeals request.

Calculate the time limit for filing each level of appeal

Once an initial claim determination is made, providers, participating physicians, and other suppliers have the right to appeal. Physicians and other suppliers who do not take assignment on claims have limited appeal rights.
Medicare offers five levels in the Part A and Part B appeals process. In addition, minor errors or omissions on certain Part B claims may be corrected outside of the appeals process using a process known as a clerical reopening.
The five levels of appeals, listed in order, are:

Appeal level
Time limit for filing request
Where to file an appeal
First level: Redetermination
120 days from the initial claim determination
Submit request by: 
Medicare administrative contractor (MAC)
Second level: Reconsideration
180 days from the redetermination decision
Submit request by: 
Qualified independent contractor (QIC)
Third level: Administrative law judge hearing (ALJ)
60 days from the date of the reconsideration decision
Submit request by: 
*Monetary threshold for requests filed on or before December 31, 2020, is $170. For requests made on or after January 1, 2021, the threshold is $180.
Office of Medicare Hearings and Appeals
Fourth level: Medicare Appeals Council
60 days from the date of the ALJ decision
Submit request by: 
Departmental Appeals Board
Fifth level: Judicial review:
60 days from the date of the Medicare Appeals Council decision
Submit request by: 
*Monetary threshold for requests made on or before December 31, 2020, is $1,670. For requests made on or after January 1, 2021, the threshold is $1,760.
Federal District Court
*Monetary threshold (also known as the amount in controversy or AIC), is the dollar amount required to be in dispute to establish the right to a particular level of appeal. Congress establishes the amount in controversy requirements. The amount in controversy required when requesting an administrative law judge hearing or judicial review is increased annually by the percentage increase in the medical care component of the consumer price index for all urban consumers.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.