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Hearing by an Administrative Law Judge (ALJ)

After the Part C Independent Review Entity (IRE) issues a decision, any party to the reconsideration (except the Medicare Advantage organization) who is dissatisfied with the reconsidered determination may appeal the IRE's decision by requesting an Administrative Law Judge (ALJ) hearing.

The appeal request must be filed within 60 calendar days from the date of the notice of the IRE's reconsideration decision.

All requests must be made in writing.

How to Request a Hearing by an ALJ

In order to request a hearing by an ALJ, the amount remaining in controversy must meet the threshold requirement. This amount may change each year. For calendar year 2018, the AIC threshold is $160. For calendar year 2019, the amount in controversy remains at $160. To view the Federal Register AIC notices, see the "Related Links" section below.   

For more information about requesting a hearing with an ALJ, see section 100.1, and for information about how the amount remaining in controversy is computed, see section 100.2 in Chapter 13 of the Medicare Managed Care Manual in the "Downloads" section below.

The Office of Medicare Hearings and Appeals (OMHA) is responsible for administering ALJ hearings.  For more information about how to request an ALJ hearing or how to contact the Office of Medicare Hearings and Appeals, click on the link in the "Related Links" section below.

The decision will contain the information needed to file a request for review by the Medicare Appeals Council.