Medicare Advantage appeal deadlines for providers (2026, verified)
Medicare Advantage appeal clocks are set by federal regulation (42 CFR Part 422) and are uniform nationwide — plans cannot shorten them. The level-1 reconsideration window runs from receipt of the organization determination, and receipt is presumed to occur 5 calendar days after the date on the notice unless there is evidence to the contrary.
Per Appealant’s verified payer-deadline database, every value on this page is quoted verbatim from a primary source — the governing federal or California regulation — with the source linked and its effective date shown (sources re-retrieved 2026-07-04).
Calendar, business, and working days are not interchangeable, and month-based windows are never converted to day counts. Source documents were re-retrieved and verified 2026-07-04.
What is the level 1 reconsideration filing deadline for Medicare Advantage (Part C) appeals?
60 calendar days, counted from receipt of written organization determination notice. Verified verbatim by Appealant from the primary source — 42 CFR § 422.582(b), effective 2025-01-01 — most recently re-retrieved 2026-07-04.
What is the level 1 reconsideration receipt presumption deadline for Medicare Advantage (Part C) appeals?
5 calendar days, counted from date on written organization determination. Verified verbatim by Appealant from the primary source — 42 CFR § 422.582(b)(1), effective 2025-01-01 — most recently re-retrieved 2026-07-04.
What is the level 3 ALJ filing deadline for Medicare Advantage (Part C) appeals?
60 calendar days, counted from receipt of IRE reconsidered determination notice. Verified verbatim by Appealant from the primary source — 42 CFR § 422.602(b), effective 2002-01-01 — most recently re-retrieved 2026-07-04.
Full rules table, with verbatim sources
| Rule | Value | Clock starts | Applies to | Verbatim source text |
|---|---|---|---|---|
| Level 1 reconsideration filing | 60 calendar days | receipt of written organization determination notice | Provider deadline | a request for reconsideration must be filed within 60 calendar days after receipt of the written organization determination notice. 42 CFR § 422.582(b) (effective 2025-01-01) |
| Level 1 reconsideration receipt presumption | 5 calendar days | date on written organization determination | Provider deadline | The date of receipt of the organization determination is presumed to be 5 calendar days after the date of the written organization determination, unless there is evidence to the contrary. 42 CFR § 422.582(b)(1) (effective 2025-01-01) |
| Level 1 standard decision services | 30 calendar days | receipt of reconsideration request | Payer / reviewer clock | no later than 30 calendar days from the date it receives the request for a standard reconsideration 42 CFR § 422.590(a)(1) (effective 2002-01-01) |
| Level 1 standard decision payment | 60 calendar days | receipt of reconsideration request | Payer / reviewer clock | no later than 60 calendar days from the date it receives the request for a standard reconsideration 42 CFR § 422.590(b)(1) (effective 2002-01-01) |
| Level 1 part b drug decision | 7 calendar days | receipt of reconsideration request | Payer / reviewer clock | no later than 7 calendar days from the date it receives the request for a standard reconsideration. This 7 calendar-day period may not be extended 42 CFR § 422.590(c)(1) (effective 2002-01-01) |
| Level 1 expedited decision | 72 hours | receipt of expedited request | Payer / reviewer clock | no later than 72 hours after receiving the request 42 CFR § 422.590(e)(1) (effective 2002-01-01) |
| Level 1 extension | 14 calendar days | original deadline | Payer / reviewer clock | the MA organization may extend the standard or expedited reconsideration deadline for services by up to 14 calendar days if… 42 CFR § 422.590(f) (effective 2002-01-01) |
| Level 2 IRE review | 30 calendar days | date IRE receives case file | Payer / reviewer clock | Maximus is responsible for completing the IRE reconsideration within the same timeframes and standards that apply to Medicare Health Plans. 42 CFR § 422.592(b) + Maximus Part C IRE Reconsideration Process Manual (Rev. 2024), § 6.1 (effective 2002-01-01) |
| Level 3 ALJ filing | 60 calendar days | receipt of IRE reconsidered determination notice | Provider deadline | a party must file a request for a hearing within 60 calendar days of receipt of the notice of a reconsidered determination… the date of receipt of the reconsideration is presumed to be 5 calendar days after the date of the notice of the reconsidered determination, unless there is evidence to the contrary. 42 CFR § 422.602(b) (effective 2002-01-01) |
| Level 3 ALJ AIC threshold 2026 | 200 (dollars — amount-in-controversy threshold, not a deadline) | — | Provider deadline | The CY 2026 AIC threshold amount for ALJ hearings is $200.00… effective for requests for ALJ hearings and judicial review filed on or after January 1, 2026. 90 FR 55869 (Dec. 4, 2025) — CY 2026 AIC Threshold (effective 2026-01-01) |
| PA standard decision 2026 | 7 calendar days | receipt of PA request | Payer / reviewer clock | 7 calendar days after receiving the request 42 CFR § 422.568(b)(1)(ii) (CMS-0057-F) + CMS-0057-F fact sheet (effective 2026-01-01) |
| Organization determination standard non PA | 14 calendar days | receipt of request | Payer / reviewer clock | 42 CFR 422.568(b)(1): standard organization determinations — (i) items/services not subject to prior authorization: 14 calendar days 42 CFR § 422.568(b)(1)(i) (no stated effective date) |