General Appeals Information
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.
Appeals |
Time Limit |
Minimum Amount in Controversy |
Notes |
---|---|---|---|
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 five days from the date of the notice. |
None |
You must file a Redetermination Request before filing a Reconsideration Request with the QIC. |
Reconsideration: |
180 days from receipt of the redetermination. |
None |
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. |
$180 for requests filed on or before December 31, 2023. $180 for requests filed on and after January 1, 2024. |
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. |
$1,850 for requests filed on or before December 31, 2023. $1,840 for requests filed on or after January 1, 2024. |
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