US · guidance
CMS Pub. 100-04, ch. 34, § 10.7
Timeframes to Complete a Reopening Requested by a Party
There are no timeframes established in statute or regulation governing the timeframes for
a contractor to complete a reopening action. However, a party to an initial determination
has a reasonable expectation to the administrative finality of a determination issued by
Medicare. Therefore, this section sets out timeframes to complete the reopening action
once the reopening has been initiated. These timeframes apply only to those reopening
requests that are requested by the party to the initial determination. These timeframes do
not apply to contractor initiated reopenings.
For those reopenings requested by a party that the contractor agrees to reopen, the
contractor shall complete the reopening action 60 days from the date of receipt of the
party’s reopening request in the corporate mailroom, receipt in a secure Internet
portal/application, or receipt of the telephone request. This does not apply to “big box
cases” defined as aggregated requests filed by a provider, physician, or other supplier that
involve 40 or more beneficiaries/claims and $40,000 or more in controversy.
History
(Rev. 2241; Issued: 06-17-11, Effective: 10-01-11, Implementation: 10-03-11)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
95b70f9b601d50c87f1feeaa7fd32891fd416e73a5fc48b56e7f7a6fe29d2724
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