CMS Pub. 100-04, ch. 29, § 240.5

If a party files an untimely request for redetermination and there is insufficient or no explanation for the

delay or no other evidence that establishes the reason for late filing, the MAC dismisses the redetermination

request. The MAC explains in the dismissal letter that the party can: 1) request that the MAC vacate the

dismissal by providing an explanation for the late filing to the MAC within 6 months of the dismissal of the

redetermination request; and 2) request that the QIC review the MAC’s dismissal action by filing a request

with the QIC within 60 days of the date of receipt of the dismissal notice.

If an explanation or other evidence is submitted within 6 months from the dismissal that contains sufficient

evidence or other documentation that supports a finding of good cause for late filing, the MAC (as

applicable) makes a favorable good cause determination. Once it makes a favorable good cause

determination, it considers the appeal to be timely filed and proceeds to vacate its prior dismissal and

performs a redetermination (see §310.6.3 Processing Requests to Vacate Dismissals).

The closed date is the date of the dismissal, and the dismissal is reported on the Contractor Reporting of

Operational Workload Data (CROWD) in the appropriate appeals report forms (Carriers Appeals Report

Form CMS-2590, Monthly Intermediary Part A and Part B Appeals Report Form CMS-2591, or Monthly

Statistical Report on Intermediary and Carrier Part A and Part B Appeals Activity Form CMS-2592). The

closed date and date of dismissal are also captured in the Medicare Appeals System (MAS) and can be

appropriately reported on by the Part A MACs.