Federal programs / Medicare Advantage (Part C)
Medicare Advantage (Part C)
Plans use their own reconsideration form, but none is required: a signed written request with the enrollee's name, Medicare number and the service denied is enough. If the plan upholds the denial it must send the case to the Independent Review Entity itself.
| Form | Use it to | Deadline | Issued by |
|---|---|---|---|
| Plan reconsideration request (plan-specific) | Level 1: written request to the plan | 65 days from the date on the denial notice (42 CFR 422.582) | Your plan; CMS rules |
| CMS-1696, Appointment of Representative | Let someone act for you | With the appeal | CMS |
| How to file an appeal (Medicare.gov) | The official walk-through for every Medicare appeal type | See the notice | Medicare.gov |
Where it goes
The appeals address on the plan's denial notice; fax numbers are usually listed. Expedited (72-hour) requests can be made by phone.
The rule
42 CFR Part 422, Subpart M. 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.