If you are dissatisfied with an initial claim determination you have the right to request an appeal. There are several appeal levels and each level must be processed before proceeding to the next level. The table shown below includes information on each of the appeal levels, the amount in controversy thresholds and the time limits for filing an appeal.

AppealsTime LimitMinimum Amount in ControversyNotes
Redetermination (initial appeal)

120 days from the date of the initial claim determination notice

None

You must file a Redetermination Request before filing a Reconsideration Request with the QIC.
Reconsideration - Qualified Independent Contractor (QIC)

180 days from receipt of the redetermination

None

Reconsideration requests should be mailed directly to the QIC. The address for the QIC is included in the redetermination letter. You should include a copy of the redetermination decision letter with your reconsideration request. 

Administrative Law Judge (ALJ)

 

60 days from receipt of the QIC decision

$170 for requests filed on or before December 30, 2020

$180 for requests filed on and after January 1, 2021

The QIC decision letter will provide the HHS OMHA office to which an ALJ request is mailed.
Departmental Appeals Board Review (DAB)/Appeals Council

60 days from the date of the ALJ decision or dismissal

 None

  
Federal District Court Review

60 days from the date of the Appeals Council decision

$1,670 for requests filed on or before December 31, 2020

$1,760 for requests filed on or after January 1, 2021

 

Contact Palmetto GBA JJ Part A Medicare

Provider Contact Center: 877-567-7271

Email JJ Part A

Contact a specific JJ Part A department


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