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.
Day types are not interchangeable: calendar, business, and month windows each count differently, and month windows are never converted to days. Every value below is quoted from its primary source.
Deadlines you must hit
Level 1 reconsideration filing
60 calendar daysClock starts: receipt of written organization determination notice
a request for reconsideration must be filed within 60 calendar days after receipt of the written organization determination notice.
Source: 42 CFR § 422.582(b)
Level 1 reconsideration receipt presumption
5 calendar daysClock starts: date on written organization determination
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.
Source: 42 CFR § 422.582(b)(1)
Level 3 ALJ filing
60 calendar daysClock starts: receipt of IRE reconsidered determination notice
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.
Source: 42 CFR § 422.602(b)
Level 3 ALJ AIC threshold 2026
$200 thresholdThe 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.
Payer response clocks
Level 1 standard decision services
30 calendar daysClock starts: receipt of reconsideration request
no later than 30 calendar days from the date it receives the request for a standard reconsideration
Source: 42 CFR § 422.590(a)(1)
Level 1 standard decision payment
60 calendar daysClock starts: receipt of reconsideration request
no later than 60 calendar days from the date it receives the request for a standard reconsideration
Source: 42 CFR § 422.590(b)(1)
Level 1 part b drug decision
7 calendar daysClock starts: receipt of reconsideration request
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
Source: 42 CFR § 422.590(c)(1)
Level 1 expedited decision
72 hoursClock starts: receipt of expedited request
no later than 72 hours after receiving the request
Source: 42 CFR § 422.590(e)(1)
Level 1 extension
14 calendar daysClock starts: original deadline
the MA organization may extend the standard or expedited reconsideration deadline for services by up to 14 calendar days if…
Source: 42 CFR § 422.590(f)
Level 2 IRE review
30 calendar daysClock starts: date IRE receives case file
Maximus is responsible for completing the IRE reconsideration within the same timeframes and standards that apply to Medicare Health Plans.
Source: 42 CFR § 422.592(b) + Maximus Part C IRE Reconsideration Process Manual (Rev. 2024), § 6.1
PA standard decision 2026
7 calendar daysClock starts: receipt of PA request
7 calendar days after receiving the request
Source: 42 CFR § 422.568(b)(1)(ii) (CMS-0057-F) + CMS-0057-F fact sheet
Organization determination standard non PA
14 calendar daysClock starts: receipt of request
42 CFR 422.568(b)(1): standard organization determinations — (i) items/services not subject to prior authorization: 14 calendar days
Source: 42 CFR § 422.568(b)(1)(i)
Reference information for provider billing teams, not legal advice. Windows depend on the plan's regulator and product, so confirm against your contracted provider manual. Sources retrieved 2026-07-04.