Common use of Medicare Appeals Council Clause in Contracts

Medicare Appeals Council.  If the ALJ decides against you, you must request a review by the Medicare Appeals Council within 60 days of receiving the ALJ’s decision.  For beneficiary-initiated appeals, the Appeals Council should make a decision within 90 days of receiving the request for a hearing. Federal District Court  If the Appeals Council decides against you, follow the directions in the denial to file for judicial review in federal district court.  You must file within 60 days of receiving the Appeals Council’s decision.  You must meet the amount in controversy requirement. The amount in controversy is adjusted annually.

Medicare Appeals Council.  ✓ If the ALJ decides against you, you must may request a review by the Medicare Appeals Council within 60 days of receiving the ALJ’s decision.  ✓ For beneficiary-initiated appeals, the Appeals Council should make a decision within 90 days of receiving the request for a hearing. Federal District Court  ✓ If the Appeals Council decides against you, follow the directions in the denial to file for judicial review in federal district court.  ✓ You must file within 60 days of receiving the Appeals Council’s decision.  ✓ You must meet the amount in controversy requirement. The amount in controversy is adjusted annually.

Medicare Appeals Council.  ✓ If the ALJ decides against you, you must request a review by the Medicare Appeals Council within 60 days of receiving the ALJ’s decision.  ✓ For beneficiary-initiated appeals, the Appeals Council should make a decision within 90 days of receiving the request for a hearing. Federal District Court  ✓ If the Appeals Council decides against you, follow the directions in the denial to file for judicial review in federal district court.  ✓ You must file within 60 days of receiving the Appeals Council’s decision.  ✓ You must meet the amount in controversy requirement. The amount in controversy is adjusted annually.