Appeal Deadlines by Payer and Level
An appeal deadline is how long you have to dispute a denial after the payer's determination. Like filing limits, these are set by contract and plan and differ between commercial, Medicare Advantage, and Medicaid lines under the same payer name. The values below are commonly published general windows. Medicare fee-for-service is the exception — its levels and timeframes are set in federal regulation and are exact. Always confirm the commercial numbers against your contract and the remit's appeal instructions.
| Payer / track | Appeal level | Deadline to file (commonly) |
|---|---|---|
| Medicare FFS | Redetermination (MAC) | 120 days from the initial remittance |
| Medicare FFS | Reconsideration (QIC) | 180 days from the redetermination decision |
| Medicare Advantage | Plan-level appeal / reconsideration | 60 days from the denial (plan-specific) |
| Commercial (UHC / Aetna / Cigna / Humana) | First-level appeal | ~60–180 days from the denial (confirm per contract) |
| Commercial | Second-level appeal | ~60–180 days from the first-level decision (plan-specific) |
| Commercial | External / independent review | Typically ~4 months after final internal denial (ACA plans) |
| Medicaid (state-specific) | Plan appeal, then state fair hearing | Varies by state — commonly 60–120 days; check the state manual |
What to do with this
- Read the appeal instructions printed on the remit or in the denial letter first — the deadline and the correct level are usually stated there.
- Commercial payers often have two internal appeal levels before an external review; missing the first-level window can forfeit the rest.
- For ACA-regulated plans, patients (or providers on their behalf) generally get an external independent review after the final internal denial — a real lever when the payer won't move.
- Medicare Advantage runs on tighter clocks than Medicare fee-for-service; don't assume the FFS 120-day window applies.
Volari attaches the right appeal level and deadline to each denial based on payer and line of business, then routes it so the strongest appeal is filed inside the window — not after the clock has quietly run out.
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