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CGS Administrators, LLC

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Appeals Timelines

Each Appeals process has specific timelines and requirements. Review the table below for specific timelines and monetary thresholds applied to each of the Appeals processes:

Appeal Level Time Limit for Filing Request Monetary Threshold
Redetermination 120 days from the date of receipt of the initial determination or overpayment demand letter None
Reconsideration 180 days from the date of receipt of the Medicare Redetermination Notice None
Administrative Law Judge (ALJ) 60 days from the date of receipt of the reconsideration notice For requests filed prior to January 1, 2020, at least $160 remains in controversy.

For requests filed on or after January 1, 2020, at least $170 remains in controversy.
Departmental Appeals Board (DAB) Review/Appeals Council 60 days from the date of receipt of the ALJ decision/dismissal None
Federal Court (Judicial) Review 60 days from the date of receipt of the Appeals Council decision or declination of review by DAB For requests filed prior to January 1, 2020, at least $1,630 remains in controversy.

For requests filed on or after January 1, 2020, at least $1,670 remains in controversy.

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