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If an Administrative Law Judge (ALJ) issues an adverse decision, the enrollee may appeal the decision by requesting a review by the Medicare Appeals Council (MAC). An enrollee or an enrollee's appointed representative may request a review by the MAC. An enrollee's prescribing physician may not request a review by the MAC on an enrollee's behalf unless the enrollee's physician is also the enrollee's appointed representative. For more information about appointing a representative, see section 10.4 in Chapter 18 of the Prescription Drug Benefit Manual. You may view Chapter 18 of the Prescription Drug Benefit Manual by clicking on the link 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, which includes by fax. The request may be made on Appeal Form DAB-101, which can be obtained by clicking on the link in "Related Links Outside CMS" section below. For more information about how to request a review with the MAC, you may click on the related link in the "Related Links Outside CMS" section below. Also, section 100 in Chapter 18 of the Prescription Drug Benefit Manual contains more information about the MAC process. You may view Chapter 18 of the Prescription Drug Benefit Manual by clicking on the link in the "Downloads" section below. If the MAC's decision is unfavorable, the decision will contain the information an enrollee needs 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: 01/20/2009 9:02:21 AM
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