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Appeal deadlinesThe clock depends on the payer, and on whether it runs from the date on the notice or the day you got it. Here are the federal floors, a worked calendar and the regulations behind each.
As of October 2026, the federal floors are 120 days from receipt for Medicare redeterminations, 60 days from receipt for Medicare Advantage (65 days from the notice date, per CMS), 60 days from the notice date for Medicaid managed care plans and at least 180 days for ACA and employer plans. Commercial provider contracts set their own, often shorter, limits.
| Payer | First-level appeal | Deadline | Clock starts | Rule |
|---|---|---|---|---|
| Medicare (traditional) | Redetermination by the Medicare contractor | 120 days | Receipt of the initial determination, presumed 5 days after the notice date | 42 CFR 405.942 |
| Medicare Advantage | Reconsideration by the plan | 60 days (CMS: 65 days from the notice date) | Receipt of the written organization determination, presumed 5 days after its date | 42 CFR 422.582 |
| Medicaid managed care | Appeal to the plan | 60 days | The date on the adverse benefit determination notice | 42 CFR 438.402(c)(2)(ii) |
| ACA individual plans and employer group plans (non-grandfathered) | Internal appeal | At least 180 days | Receipt of the adverse benefit determination | 45 CFR 147.136, applying 29 CFR 2560.503-1(h)(3)(i) |
| Commercial plans, provider disputes | Per your contract | Varies | Per your contract | Your participation agreement and state law |
Where the rule stands
Say a denial notice is dated Monday, March 2, 2026, and you can't prove you got it any earlier or later than the presumed 5 days.
| Payer | Last day to file | How it's counted |
|---|---|---|
| Medicaid managed care | Friday, May 1, 2026 | 60 days from March 2 |
| Medicare Advantage | Wednesday, May 6, 2026 | Receipt presumed March 7, plus 60 days (the same day as 65 days from March 2) |
| Medicare (traditional) | Sunday, July 5, 2026 | Receipt presumed March 7, plus 120 days. File by Thursday, July 2 |
| ACA or employer plan | Thursday, September 3, 2026 | Receipt presumed March 7, plus 180 days (check the plan's notice for its own date) |
The same notice date gives deadlines four months apart, so a single "90-day" rule in your queue misses the short ones.
Most of these rights belong to the patient, the enrollee or a party to the determination, so providers often appeal as a representative.
In Medicaid managed care, a provider may appeal for the enrollee only if state law allows it and the enrollee gives written consent (42 CFR 438.402(c)(1)(ii)). For ACA and employer plans, the appeal right sits with the claimant, so get a designation of representative on file early.
Provider-to-plan payment disputes under a commercial contract are a separate track with the contract's own limit. That limit is often the shortest one in your queue.
Medicare contractors can extend the 120 days when a party shows good cause in writing, such as serious illness, records destroyed by accident or a notice that never arrived (42 CFR 405.942(b)). Medicare Advantage plans can too (42 CFR 422.582). Don't plan around it.
Load the payer-specific deadline onto every denial the day it posts. Set the internal target at about two-thirds of the window, so records requests and clinical review have room.
What a denied claim costs shows the claim value below which an appeal loses money, and what a good denial rate is shows how to read the trend behind the queue.
Patients rarely appeal on their own. KFF found fewer than 1% of denied in-network HealthCare.gov claims were internally appealed in 2024, so if your team doesn't act, nobody will.
TSI's denial management team scores each denial for deadline risk alongside value, so the short-window payers get worked first.
Results vary by payer mix and client program.
120 days from the date you receive the initial determination. Receipt is presumed to be 5 days after the date on the notice unless there's evidence otherwise (42 CFR 405.942).
Both describe the same window. The regulation gives 60 days from receipt of the notice, with receipt presumed 5 days after its date (42 CFR 422.582). CMS's guidance states it as 65 days from the date of the notice.
For ACA and employer plans with one appeal level, federal rules allow up to 30 days for pre-service claims, 60 days for post-service claims and 72 hours for urgent care (29 CFR 2560.503-1(i)). Plans with two levels get half each.
No. A corrected claim fixes an error in what you billed and usually follows the payer's timely filing rules. An appeal disputes the payer's decision. Check which one the denial reason calls for before you start the clock.
General information, current as of Nov 5, 2026. It isn't legal advice. Rules change and differ by state, so check the sources linked here and talk to your own counsel before you act on it.
The Denials Economics Sprint takes one payer and one denial class, sets a baseline and reports overturn rate, days to appeal, cost per claim and the claims worth working.
