Part D RAC Appeals Process
Appeals Process for Identified Overpayments by the Medicare Part D Recovery Audit Contractor (RAC)
When must appeals be filed?
Appeals that are submitted after the established deadline will be dismissed without the ability to re-file. If the deadline falls on a weekend or a Federal Holiday, the filing period will be extended to the next business day. Electronic submissions will be considered timely if they are received in the designated appeals mailbox by 11:59 p.m. EST on the deadline date. Physical submissions that are mailed must be postmarked by the date of the deadline. The deadlines are as follows:
Level I, Request for Redetermination: Level I appeals must be filed no later than 30 calendar days from the date of the Notification of Improper Payment.
Level II, Request for Reconsideration: Level II appeals must be filed no later than 15 calendar days from the issuance date of the Level I review decision.
Extension of established deadlines: In very limited circumstances, CMS may grant a request to extend the deadline. The decision to grant such an extension is entirely at the discretion of CMS, and the Part D plan sponsor must show that extenuating circumstances (e.g. natural disaster, Notification of Improper Payment went to incorrect address, death, etc.) existed that prevented the filing of an appeal by the deadline. Circumstances involving staff turnover or an oversight of the established deadline will not be considered.
Additional information regarding the Part D RAC Appeals Process can be found in the download section below.