Medicare Managed Care Review by the Medicare Appeals Council
Guidance for requesting review if Administrative Law Judge (ALJ) or attorney adjudicator with the Office of Medicare Hearings and Appeals (OMHA) issues a decision on an appeal, any party to the hearing, including the MA organization, who is dissatisfied with the decision, may request that the Medicare Appeals Council (Appeals Council) review the decision.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: January 08, 2020
After an Administrative Law Judge (ALJ) or attorney adjudicator with the Office of Medicare Hearings and Appeals (OMHA) issues a decision on an appeal, any party to the hearing, including the MA organization, who is dissatisfied with the decision, may request that the Medicare Appeals Council (Appeals Council) review the decision.
How to Request a Review by the Appeals Council
The request must be made in writing and filed with the Appeals Council within 60 calendar days after receipt of the ALJ's or attorney adjudicator's decision. An appellant may request the review using Appeal Form DAB-101, which is available in the "Related Links" section below.
For more information about how to request a review with the Appeals Council, you may visit the Medicare Appeals Council website using the link in the "Related Links" section below.
In addition, information about the Appeals Council process can be found in section 70, and information about appointing a representative can be found in section 20 of the Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance, linked in the "Downloads" section below.
The Appeals Council's decision will contain the information needed to file a request for review by a Federal District Court.
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