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The five levels of appeal in CMS begin with redetermination by the Medicare contractor and progress through levels including reconsideration, hearing by an administrative law judge, review by the Medicare Appeals Council, and finally judicial review in federal court. Each level serves as an opportunity for providers to challenge claim denials and seek proper reimbursement. Understanding these appeal levels ensures healthcare providers can navigate disputes effectively. By mastering this process, organizations can align their practices with CMS-20031 standards.
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