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Denials and Appeals/Advanced/30 minutes/Reviewed 2026-07-10

Original Medicare Appeals: Five Levels and Deadlines

Build an appeal from redetermination through judicial review, starting with the remittance and deadline.

Quick answer

Original Medicare has five appeal levels. The first is MAC redetermination, generally requested within 120 days of receiving the initial determination; later levels have different deadlines, amount-in-controversy rules, and filing destinations.

Rules to know

  • Read appeal rights on the actual determination notice.
  • Redetermination is performed by MAC personnel not involved in the initial determination.
  • Minor claim errors may be corrected outside appeal.
  • Evidence should be organized around each coverage, coding, and documentation element.

Operational workflow

  1. 01Calendar the deadline from notice receipt.
  2. 02Identify appellant, claim, service, disputed determination, and requested outcome.
  3. 03Build a source-indexed evidence packet.
  4. 04File with the destination and method on the notice.
  5. 05Track decision due date and preserve rights to the next level.

Common failure modes

  • Using a beneficiary appeal timeframe for a different payer process.
  • Submitting records without explaining how they answer the denial.
  • Mailing to an address not listed for that determination.

Knowledge check

What is the first Original Medicare fee-for-service appeal level?

Official sources

Original Medicare Fee-for-Service AppealsCenters for Medicare & Medicaid ServicesReviewed 2026-07-10First Level of Appeal: Redetermination by a Medicare ContractorCenters for Medicare & Medicaid ServicesReviewed 2026-07-10

Continue this track

IntermediateHow to Read an ERA: Group Codes, CARCs, and RARCsIntermediateCorrected Claim, Reopening, or Appeal?

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