Appeals
Medicare Claims Processing Manual (Pub 100-04 Ch. 29) 
A provider or beneficiary may appeal an initial claim determination when Medicare’s decision is to deny or reduce payment based on §1862(a)(1), §1834(a)(17)(B), §1834(j)(1), or §1834(a)(15). Medicare provides five possible levels of appeal in the following order:
- Redetermination
- Reconsideration
- Administrative Law Judge (ALJ) Hearing
- Appeals Council Review
- Final Judicial Review
For additional information, refer to the following items.
- The Medicare Appeal Process Quick Reference Tool
- Adjustments or Add-ons to Appealed Claims
- Medicare
Appeals Process: Five Levels to Protect Providers, Physicians, and
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Page last updated: May 5, 2008