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2nd Level of Appeal – Reconsideration

Physicians, suppliers, and beneficiaries have the right to appeal claim determinations made by MACs. The purpose of the appeals process is to ensure the correct adjudication of claims. Appeals activities conducted by MACs are governed by the Centers for Medicare & Medicaid Services (CMS). As a MAC, CGS handles the first level of appeal, redetermination requests. There are five levels of appeal.

Time Limit for Filing Request

180 days from the date of receipt of the redetermination. NOTE: If a party requests QIC review of a contractor's dismissal of a request for redetermination, the time limit for filing a request for reconsideration is 60 days from the date of receipt of the contractor's dismissal notice.

Monetary Threshold to be Met


Submitting a Reconsideration

If you are a myCGS Portal user, you can submit the 2nd level of Appeal using myCGS. Refer to the 2nd Level Appeal Job Aid for additional information.

Posted: 12.14.20


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