Medicare Advantage plan reconsideration filing window

Use this entry when the decision is an adverse organization determination from a Medicare Advantage health plan. It concerns the enrollee’s appeal, including the physician role described by CMS.

Check whose appeal this is

Enrollee-side appeal of a Medicare Advantage adverse organization determination for an item or service; a physician may act as the official source permits. Not an independent provider reimbursement/contract dispute, an Original Medicare MAC appeal, Part D drug appeal, grievance, hospital discharge appeal or IRE filing. Expedited clinical qualification and a late-filing extension are not determined here.

Source verification required. The filing window and submission guidance are withheld because the source changed, expired or is unavailable.

Official CMS source — CMS public summary: 65-day notice-date description; read with receipt-qualified 422.582 · checked 2026-10-15

CMS summary read together with the October15,2026 regulatory snapshot. Contrary receipt evidence, actual notice and late-filing assessment remain separate; source review required by October22,2026. No historical rule reconstruction.

Regulatory source — 42 CFR 422.582, dated2026-10-15: receipt-qualified filing, rebuttable5day presumption and request-received event · checked 2026-10-18

Part C directory record · For a Part D drug denial, identify the separate appeal stage · Original Medicare provider redetermination

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