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.
- Second Level of Appeal: Reconsideration by a Qualified Independent Contractor
- Original Medicare (Fee-for-service) Appeals
- Claims Processing Manual, Pub. 100-04, Chapter 29 – Appeals and Claims Decisions
- CMS Medicare Part A & B Appeals Process
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 |
None |
Submitting a Reconsideration |
If you are a myCGS Portal user, you can submit the 2nd level of Appeal using myCGS. Refer to the Appeals section of the myCGS User Manual for additional information. |
Posted: 12.06.23