Federal programs / Federal external review (HHS-administered states and self-funded employer plans)
Federal external review (HHS-administered states and self-funded employer plans)
Where a state has no external review process, or for self-funded employer plans, the federal process applies: an accredited independent review organization, requested within four months of the final internal denial.
| Form | Use it to | Deadline | Issued by |
|---|---|---|---|
| External appeals (CMS CCIIO) | How the HHS-administered external review works and how to request it | 4 months after the final internal denial (45 CFR 147.136(d)) | CMS |
| HealthCare.gov: appealing an insurance company decision | Plain-language walk-through for Marketplace plans | See the notice | HealthCare.gov |
Where it goes
The federal external review contractor (MAXIMUS Federal Services) by the request form on the CMS page, fax or mail; the denial notice must name the process that applies.
The rule
45 CFR 147.136(d); 29 CFR 2560.503-1 for ERISA plans. Links verified 2026-09-15; the notice you received controls over anything here.
Want the appeal itself written to the criteria, with the rule cited? Apellica's generator is free; a reviewer can also read the denial first.