Appeal Process Flow Chart

Original Medicare (Parts A and B Fee-For-Service) Appeals Process Third Level of Appeal Fourth Level of Appeal AIC = Amount In Controversy Fiscal Intermediary (FI), Carrier, or Medicare Administrative Contractor (MAC) Determination FI, Carrier, or Medicare Administrative Contractor Redetermination 60 day time limit Office of Medicare Hearings and Appeals AIC=> $120 90 day limit Medicare Appeals Council 90 day time limit for processing Federal District Court AIC=> $1,220 120 days to file 60 days to file 60 days to file Medicare Appeals Council may decline review 60 days to file Quality Improvement Organization Redetermination 72 hour time limit Qualified Independent Contractor Reconsideration 72 hour time limit Standard Process Part A and B Expedited Process (Some Part A only) Notice of Discharge or Service Termination Qualified Independent Contractor Reconsideration 60 day time limit 180 days to file Noon the next calendar day Noon the next calendar day Initial Decision First Level of Appeal Second Level of Appeal Final Level of Appeal