CMS Pub. 100-04, ch. 29, § 240.3

Providers, Physicians, or Other Suppliers

(Rev. 4278, Issued: 04-12-19, Effective: 06-13-19, Implementation: 06-13-19)

In general, A/B MACs (A), (B), (HHH), and DME MACs should not routinely find good cause when a

provider, physician or other supplier submits an untimely appeal request. However, good cause may be

found when the record clearly shows, or the provider, physician or other supplier alleges and the record

does not negate, that the delay in filing was due to one of the following:

• Incorrect or incomplete information about the subject claim and/or appeal was furnished by

official sources (CMS, the MACs, or the Social Security Administration) to the provider,

physician, or other supplier; or

• Unavoidable circumstances that prevented the provider, physician, or other supplier from timely

filing a request for redetermination. Unavoidable circumstances encompass situations that are

beyond the provider, physician or supplier’s control, such as major floods, fires, tornados, and other

natural catastrophes.

NOTE: Failure of a billing company or other consultant (that the provider, physician, or other supplier has

retained) to timely submit appeals or other information is NOT grounds for finding good cause for late

filing. The MAC does not find good cause where the provider, physician, or other supplier claims that lack

of business office management skills or expertise caused the late filing.