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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:
Level 1 — Redetermination
- How to Request A Redetermination
- Time Limit for Submitting a Redetermination Requests
- Medical Record Documentation
- Liability When Medical Records are Requested
- Notice of Redetermination Decision
- Written Assurance Letters
Level 3 — Administrative Law Judge (ALJ) Hearing
Level 4 — Appeals Council Review
Level 5 — Final Judicial Review
Appeal Status
To determine if Cahaba has received your appeal request, refer to the “Online Reports View” section of the FISS Reference Guide.
Additional Resources
- Appeals Frequently Asked Questions
- The Medicare Appeals Process Quick Reference Tool
- Appeals Process Online Course
- Adjustments to Appealed Claims
- Medicare
Appeals Process: Five Levels to Protect Providers, Physicians, and
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Page last updated: May 13, 2010
