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If an Administrative Law Judge (ALJ) issues an adverse decision on an appeal, the enrollee may further appeal the decision by requesting a review by the Medicare Appeals Council (MAC). A Medicare health plan, an enrollee, or an enrollee's representative may request a review by the MAC. For more information about appointing a representative, see section 60.1.1 in Chapter 13 of the Medicare Managed Care Manual in the "Downloads" section below. How to Request a Review by the MAC The request must be filed with the MAC within 60 calendar days from the date of the notice of the ALJ's decision. All requests must be made in writing. The enrollee may request the review using Appeal Form DAB-101, which can be obtained by clicking on the link in the "Downloads" section below. For more information about how to request a review with the MAC, you may click on the link in the "Related Links Outside CMS" section below. In addition, section 110 in Chapter 13 of the Medicare Managed Care Manual contains more information about the MAC process. You may view Chapter 13 by clicking on the link in the "Downloads" section below. If the MAC's decision is unfavorable to the enrollee, the decision will contain the information needed to file a request for review by a Federal District Court. Use the navigation tool on the left side of this page to link to subpages that contain detailed information about reviews by a Federal District Court or any other level of appeal.
Page Last Modified: 04/11/2008 5:32:20 PM
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