Your deadlines, explained

120 days from the date on the Medicare Summary Notice — 120 calendar days from when you receive it (42 CFR § 405.942(a)), with receipt presumed to be 5 days after the notice's own date unless shown otherwise.rule42 CFR 405.942

Later claims-ladder levels each have their own filing deadline, measured from the decision notice at that level rather than the original MSN — see the five claims-ladder appeal levels for each one.

The 5-day mailing presumption isn't a formality — it exists specifically because the regulation assumes you didn't get the notice the same day it was printed. If you can show you actually received it later than that, the clock can start from the real receipt date instead.

60 calendar days from when the MAC receives your timely request. Each time you submit new evidence after filing, that 60-day clock is extended by up to 14 more calendar days for that submission (42 CFR § 405.950(a), (b)(3)) — this can happen more than once.

The QIC's own reconsideration clock, once you've filed: 60 calendar days from when the QIC receives your timely request (42 CFR § 405.970). If the QIC can't meet that deadline, it must offer you the chance to escalate straight to OMHA instead of waiting (42 CFR § 405.970(e)(2)) — CaseWhy Appeals tells you the moment that right opens up.

Unlike a fast-track termination appeal, nothing on this ladder forwards itself automatically just because a deadline is missed — if your MAC or QIC misses its own clock, you generally have to actively ask to escalate to the next level rather than wait.

There's no faster, hours-scale review option on the claims ladder itself — every level here runs on a days-to-weeks clock, start to finish.

A genuinely urgent situation — a skilled nursing, home health, or hospice stay ending, or a hospital discharge or observation-status change — goes through a completely separate, same-day fast-track process instead, with its own QIO phone number and its own much shorter clock.

These specific notices come with their own same-day fast-appeal option through an outside reviewer (the QIO), separate from the claims-ladder timeline above: