Dollars matter the higher in the appeals process you go. Here are the current four levels of appeals as outlined by the HHS Office of Inspector General: LEVEL 1: CONTRACTOR REDETERMINATION At the first level, an appellant may request a redetermination with a Medicare carrier or intermediary within 120 days of receipt of the notice of the initial determination.The redetermination must be made by an individual who was not involved in the initial determination. This individual reviews evidence, including previously submitted evidence and any additional evidence that the parties submit or the individual obtains, to uphold or reject the initial determination. At levels one and two, the appellant may contest a denied claim of any dollar amount. Generally,the contractor must make a redetermination decision within 60 days of receipt of the request for redetermination. LEVEL 2: QUALIFIED INDEPENDENT CONTRACTOR (QIC) REDETERMINATION. QICs are not bound by local coverage determinations (LCDs), local medical review policies (LMRPs), or CMS program guidance, such as program memoranda and manual instructions. QICs, however, do give substantial deference to those policies, if applicable. Generally, a QIC has 60 days to make a decision from the date when the appellant filed an appeal. LEVEL 3: ADMINISTRATIVE LAW JUDGE HEARING ALJs are bound by NCDs, but an ALJ may review the facts of a particular case to determine whether an NCD applies to a specific claim and, if so, whether the NCD was applied correctly. ALJs are not bound by LCDs, LMRPs, or CMS program guidance. ALJs, however, do give substantial deference to those policies, if applicable. Generally, the ALJ must decide Part A and Part B claims appeals within 90 days of the dates appeal requests were filed. LEVEL 4: MEDICARE APPEALS COUNCIL REVIEW The MAC is not bound by LCDs, LMRPs, or CMS program guidance, but the MAC does give substantial deference to those policies, if applicable. Generally, the MAC must make a decision on Medicare Part A and Part B claims appeals within 90 days of the filing date. If the appellant disagrees with the MAC decision and the amount in controversy is at least $1,220, the appellant may file a civil action in federal district court within 60 days of receiving the MAC decision.