Which Medicare appeal comes after your last decision?
For provider billing researchers following an Original Medicare FFS administrative appeal. Read the issuing body and appeal level on the actual notice before selecting a window. The same number of days can start from different decisions and lead to different agencies.
Original Medicare provider level 3 OMHA filing window
Provider party seeking an OMHA hearing after a QIC reconsideration decision. Not a second-level filing, QIC dismissal review, escalation request, Medicare Advantage/Part D appeal, or confirmation that the annual amount threshold/other hearing eligibility is met.
Source verification required. The filing window and routing guidance are withheld until current evidence is verified.
Official CMS source — Requesting a Hearing by an ALJ — decision receipt-based filing window · checked 2026-10-15
Source does not establish a universal effective date; current guidance checked, not historical reconstruction
Original Medicare provider level 4 Medicare Appeals Council filing window
Provider party seeking Council review after an OMHA decision or dismissal. Not a direct appeal from the initial denial or QIC reconsideration; escalation from overdue OMHA proceedings follows a separate path. Not Medicare Advantage/Part D or a personal eligibility determination.
Source verification required. The filing window and routing guidance are withheld until current evidence is verified.
Official CMS source — Requesting Review by the Council — OMHA decision/dismissal receipt-based filing window · checked 2026-10-15
Source does not establish a universal effective date; current guidance checked, not historical reconstruction
Do not turn a filing window into an eligibility decision
A timing record does not establish party status, an amount in controversy, a right to aggregate claims, or entitlement to payment. QIC dismissal challenges, overdue-case escalation and federal court review have separate instructions. Preserve receipt evidence and follow the actual notice; no personalized deadline is calculated here.
Prepare an OMHA hearing request · Prepare Council review of an OMHA merits decision · Prepare OMHA review of a QIC dismissal
If your last decision is only a MAC redetermination, check second-level QIC reconsideration · Provider appeal directory · RSNAT research workspace