Refresher: Quick reference appeals time limits
Medicare Update for CAHs, December 28, 2011
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- Denial of a claim by the MAC. This is an initial determination. 120 days.
- A demand letter with an overpayment determination from a RAC. This is an appealable revised determination following reopening, 120 days.
Time limit for the issuance of a decision at each of the following levels of appeal:
- Redetermination by the MAC 60 days <42 CFR § 405.950>
- Reconsideration by the QIC 60 days <42 CFR §405.970>
- Administrative Law Judge Decision 90 days <42 CFR § 405.1016>
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