Medicare redetermination notice: what it means and what to do

Your Medicare Administrative Contractor's (MAC) written decision after you asked it to redetermine a denied claim.

A Medicare redetermination notice is your MAC's own written decision after asking it to redetermine a denied claim — the first real look-back at the original denial.

180 days from the date on the MAC's redetermination notice — 180 calendar days from when you receive it (42 CFR § 405.962), with the same 5-day receipt presumption.rule42 CFR 405.962

The reconsideration decider's own clock: 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.

An unrepresented beneficiary isn't bound by the same evidence-preclusion rules a provider or a represented appellant faces — you generally don't lose the right to raise new evidence just because you didn't submit it at the redetermination stage.

The MAC's redetermination is a genuine second look, not a rubber stamp — a different reviewer at the contractor than whoever processed the original claim actually reconsiders the file, so it's worth reading the notice for what specific reasoning changed or held, not just the bottom-line outcome.

If the redetermination notice doesn't clearly state which rule or policy it applied, it's worth asking the MAC directly, since that's the exact information a reconsideration request needs to actually rebut.

Read the decision and its own reasoning. The notice states whether your MAC upheld or reversed the original denial, and why — the specific rule or policy it applied.

Decide whether to reconsider. If the redetermination is unfavorable, you can ask a Qualified Independent Contractor (QIC) — a different, outside reviewer — to reconsider it.

Gather any new evidence. As an unrepresented beneficiary, you're not required to submit every piece of evidence at this stage — you can add more at the QIC level too.

File within your deadline. 180 days from the date on the MAC's redetermination notice — 180 calendar days from when you receive it (42 CFR § 405.962), with the same 5-day receipt presumption.