Medicare Advantage Appeal Letter Template: Complete 5-Level MA Guide 2025

Understanding Medicare Advantage Appeals: The 5-Level Process

Medicare Advantage (Part C) appeals follow a completely different process than Original Medicare. When your MA plan denies a claim or prior authorization, you have access to a 5-level appeal system with automatic protections—but only if you know how to use it.

Here's the reality independent medical practices face: Medicare Advantage plans denied over 2 million prior authorization requests in 2021. Denial rates have nearly doubled since 2020. For a practice with 40% Medicare Advantage patients billing $800,000 annually in MA claims, even a 5% denial rate means $40,000 in denied revenue.

The good news? 82% of Medicare Advantage appeals result in full or partial overturn. The problem isn't your clinical judgment—it's that only 11% of denials ever get appealed. Most practices don't appeal because manual appeal preparation takes 45-60 minutes per claim, making it economically unviable for most claim values.

Medicare Advantage vs Original Medicare: Critical Differences

Don't confuse Medicare Advantage appeals with Original Medicare appeals. They're completely different systems:

| Feature | Medicare Advantage (Part C) | Original Medicare (Parts A & B) | |---------|---------------------------|--------------------------------| | Level 1 | Reconsideration by MA plan | Redetermination by MAC | | Filing Deadline | 65 days from denial | 120 days from MSN date | | Level 2 | IRE (automatic if denied) | QIC reconsideration | | Expedited Timeline | 72 hours | 72 hours | | Level 3 Threshold | $190 (2025) | $190 (2025) | | Appeals Entity | MAXIMUS IRE | QIC contractors |

Key Difference: Medicare Advantage plans automatically forward your case to Level 2 (IRE) if they uphold the denial. You don't need to take additional action—the MA plan is required to submit your case for independent review.

The 5-Level Medicare Advantage Appeal Process

Understanding all five levels helps you know what to expect and when to escalate:

Level 1: Plan Reconsideration (65-Day Deadline)

Who Decides: Your Medicare Advantage plan (UnitedHealthcare, Humana, Aetna, etc.)

Filing Deadline: 65 calendar days from the date on the denial notice (extended from 60 days effective January 1, 2025)

Decision Timeline:

• Standard pre-service: 30 days
• Standard post-service: 30 days
• Expedited: 72 hours (if delay could harm health)

How to File:

• Written request to your MA plan (use plan's appeal form or write letter)
• Oral requests accepted by some plans for standard appeals
• Expedited appeals can be verbal or written

What Happens: Your MA plan reviews the original denial decision with any new information you provide. They can fully approve, partially approve, or uphold the denial.

Level 2: Independent Review Entity (IRE) - Automatic

Who Decides: MAXIMUS Federal Services (independent contractor, not affiliated with your MA plan)

How It Starts: Automatic—if your MA plan upholds the denial (fully or partially), they must automatically forward your case to the IRE within required timelines.

Decision Timeline:

• Standard: 30 days from IRE receipt
• Expedited: 72 hours from IRE receipt

What You Can Do: You can submit additional evidence directly to the IRE during their review. The IRE will contact you with information on how to submit documentation.

Important: You don't pay anything for IRE review—it's a free, independent evaluation required by Medicare regulations.

Level 3: Administrative Law Judge (ALJ) Hearing

Who Decides: Office of Medicare Hearings and Appeals (OMHA)—an Administrative Law Judge

Threshold: Your claim must be worth at least $190 (2025 threshold)

Filing Deadline: 60 days from the IRE decision date

Decision Timeline: OMHA aims for 90 days, but backlogs can extend this

What Happens: You can request an in-person, video, or telephone hearing before an ALJ. You can present testimony, submit additional evidence, and explain why the denial should be overturned. This is a formal legal proceeding, though you don't need an attorney (though one can help for complex cases).

Level 4: Medicare Appeals Council

Who Decides: Departmental Appeals Board (DAB) Medicare Appeals Council

Threshold: No minimum dollar amount

Filing Deadline: 60 days from ALJ decision

Decision Timeline: 90 days (target)

What Happens: The Council reviews the ALJ's decision for legal and procedural errors. They can adopt, modify, or reverse the ALJ decision, or remand it back to the ALJ for further review.

Level 5: Federal District Court

Who Decides: Federal district court judge

Threshold: Claim must be worth at least $1,900 (2025 threshold)

Filing Deadline: 60 days from Council decision

What Happens: This is a formal lawsuit in federal court. You'll almost certainly need an attorney. Very few Medicare appeals reach this level—most resolve at Level 1, 2, or 3.

Medicare Advantage Level 1 Appeal Letter Template (Standard)

Use this template for standard (non-urgent) Medicare Advantage appeals. This is your Level 1 reconsideration request.

[Your Letterhead or Contact Information]

[Date]

[Medicare Advantage Plan Name]
Appeals Department
[Address from your denial notice]

RE: Request for Reconsideration (Level 1 Appeal)
Member Name: [Full Name]
Medicare Number: [11-character Medicare ID]
MA Plan Member ID: [Plan-specific ID number]
Date of Birth: [MM/DD/YYYY]
Claim Number: [From denial notice]
Date(s) of Service: [Service date or date range]
Provider: [Physician/facility name and NPI]
Service Denied: [Description]
Procedure Code(s): [CPT/HCPCS codes]
Diagnosis: [Primary diagnosis with ICD-10 code]
Date of Denial Notice: [Date]
Reason for Denial: [As stated on denial notice]

Dear [MA Plan Name] Appeals Review Team:

I am writing to formally request reconsideration of the denial of [service/procedure/medication] for the above-referenced Medicare Advantage member. This appeal is submitted within the 65-day filing deadline pursuant to 42 CFR §422.582.

SUMMARY OF DENIAL

On [date], [MA Plan name] issued a denial for [service/procedure] stating: "[quote the denial reason verbatim from the notice]." I disagree with this determination and request that [MA Plan name] overturn this denial based on the following medical necessity and clinical evidence.

PATIENT CLINICAL PRESENTATION

[Member name] is a [age]-year-old Medicare Advantage beneficiary with [primary diagnosis - ICD-10 code] who requires [denied service/procedure] for the following clinical reasons:

**Medical History:**
- [Relevant diagnosis with onset date]
- [Comorbidities affecting treatment decisions]
- [Previous treatments and outcomes]

**Current Clinical Status:**
- [Objective clinical findings: labs, vital signs, exam findings]
- [Functional limitations or symptom severity with measurements]
- [Diagnostic imaging or test results with dates]

**Impact on Health and Function:**
- [Specific functional limitation 1: ADL impact]
- [Specific functional limitation 2: IADL impact]
- [Quality of life or health risk if service denied]

MEDICAL NECESSITY JUSTIFICATION

The denied [service/procedure/medication] is medically necessary and appropriate for [member name]'s condition for the following reasons:

**1. Evidence-Based Clinical Indication**
[Service] is the standard of care for [condition] according to [medical specialty society] clinical practice guidelines ([year]). [Cite specific guideline recommendations if available].

**2. Medicare National/Local Coverage Determination Compliance**
This service meets the criteria outlined in [NCD number if applicable, or LCD for your MAC region]. Specifically:
- [Coverage criterion 1]: [How patient meets this]
- [Coverage criterion 2]: [How patient meets this]

**3. Failed Conservative Treatment (if applicable)**
Prior to requesting [service], the following less intensive treatments were attempted without adequate clinical response:
- [Treatment 1]: [Dates], [Outcome]
- [Treatment 2]: [Dates], [Outcome]

**4. Expected Clinical Benefit**
Based on clinical evidence and the patient's presentation, [service] is expected to [specific outcome: improve function, reduce hospitalization risk, prevent disease progression, etc.]. Without this intervention, [member name] faces [specific clinical risk].

RESPONSE TO SPECIFIC DENIAL REASON

[Address the exact reason stated on the denial notice. Examples:]

**[If denied for "not medically necessary"]:** The clinical documentation clearly establishes medical necessity through objective functional limitations [cite specific measures], evidence-based guidelines [cite guidelines], and Medicare coverage criteria [cite NCD/LCD]. The service is both reasonable and necessary for this beneficiary's condition.

**[If denied for "experimental/investigational"]:** [Service] is FDA-approved for [indication] as of [date] and is widely recognized as standard of care per [medical society] guidelines. Medicare NCD [number] or LCD [number] provides coverage for this indication when [criteria] are met, which this patient satisfies.

**[If denied for "lack of documentation"]:** Complete clinical documentation is enclosed demonstrating medical necessity. Additional records are available upon request.

SUPPORTING DOCUMENTATION ENCLOSED

The following documentation supports this appeal:
- Complete clinical notes from [dates]
- [Diagnostic test] results from [date]
- [Imaging study] report and images from [date]
- Treating physician's detailed letter of medical necessity
- Failed treatment documentation (prescription records, prior visit notes)
- Relevant clinical practice guideline excerpts
- [Additional supporting documents]

REQUESTED ACTION

I respectfully request that [MA Plan name] overturn this denial and approve [service/procedure/medication] for [member name] effective [date]. The total service value is $[amount].

This beneficiary's health depends on timely access to medically necessary care. Please contact me at [phone] or [email] if additional clinical information is required to complete your reconsideration review.

If [MA Plan name] upholds this denial, I understand that the case will be automatically forwarded to the Independent Review Entity (IRE) for Level 2 review pursuant to 42 CFR §422.590.

Thank you for your prompt attention to this matter.

Sincerely,

[Physician Name], [Credentials]
[Medical License Number]
[NPI Number]
[Practice Name]
[Address]
[Phone]
[Fax]
[Email]

Enclosures: [List all attached documents]

CC: [Patient name and address]

Medicare Advantage Expedited Appeal Template (72-Hour Review)

Use this template when waiting for standard review could seriously harm the patient's health or ability to regain maximum function.

[Your Letterhead]

[Date]

[MA Plan Name] - EXPEDITED APPEALS UNIT
[Expedited Appeals Address/Fax from your plan materials]

**EXPEDITED APPEAL - 72 HOUR REVIEW REQUIRED**

RE: Expedited Reconsideration Request (Level 1 Appeal)
Member Name: [Full Name]
Medicare Number: [Number]
MA Plan Member ID: [Number]
Date of Birth: [MM/DD/YYYY]
Claim/Authorization Number: [Number]
Date(s) of Service: [Upcoming service date OR date of denied service]
Service Denied: [Description]
Date of Denial: [Date]

URGENT: EXPEDITED REVIEW REQUESTED

Dear [MA Plan] Expedited Review Team:

I am requesting expedited (72-hour) reconsideration of the denial of [service/procedure] for [member name] pursuant to 42 CFR §422.584. **This case meets expedited review criteria because applying the standard 30-day timeframe could seriously jeopardize this beneficiary's life, health, or ability to regain maximum function.**

CLINICAL URGENCY JUSTIFICATION

[Member name] requires immediate access to [denied service] for the following urgent clinical reasons:

**Immediate Health Risk:**
[Describe the specific, imminent health risk if service is delayed. Be concrete:]
- [Example: "Patient's blood pressure remains 190/105 despite maximum doses of 3 antihypertensive medications, placing patient at imminent risk for stroke or myocardial infarction."]
- [Example: "Patient's O2 saturation is 88% on room air with progressive dyspnea, requiring immediate intervention to prevent respiratory failure."]
- [Example: "Patient's pain level of 9/10 prevents ambulation and self-care, creating fall risk and rapid functional decline."]

**Time-Sensitive Nature:**
Delaying [service] for 30 days would result in:
- [Specific harm 1: e.g., "Disease progression from Stage II to Stage III"]
- [Specific harm 2: e.g., "Permanent functional loss/disability"]
- [Specific harm 3: e.g., "Hospitalization or ER visits"]

**Physician Statement:**
[Physician name], the treating physician, certifies that this case requires expedited review because [brief clinical statement about urgency].

[Follow the same structure as the standard template for the rest of the letter: Clinical Presentation, Medical Necessity, Response to Denial Reason, Supporting Documentation]

EXPEDITED DECISION TIMELINE

Pursuant to 42 CFR §422.584, I request that [MA Plan name] issue its expedited reconsideration decision within 72 hours of receiving this request. If the plan upholds this denial, I understand the case will be automatically forwarded to the IRE for expedited Level 2 review (also 72 hours).

[Member name]'s health status requires urgent resolution of this coverage determination.

Sincerely,

[Physician signature and credentials]

**Submitted by:**
[Method: Fax, Online Portal, Phone + Written Follow-up]
[Date and Time Submitted]

Medicare Advantage Post-Service Appeal Template

Post-service appeals are for services already provided that the MA plan denied payment for. The approach differs slightly from pre-service appeals:

[Follow the same basic template structure as standard appeal, with these modifications:]

RE: Post-Service Reconsideration Request (Level 1 Appeal)

[In the opening paragraph, clarify:]

This is a post-service appeal for [service/procedure] that was provided to [member name] on [date]. [MA Plan name] denied payment for this service on [denial date] stating: "[denial reason]."

[Add this section after Clinical Presentation:]

EMERGENCY/URGENCY OF SERVICE

[If service was provided emergently or urgently, explain why prior authorization wasn't obtained:]

Prior authorization was not obtained because:
- [Example: "Service was provided in emergency department for acute condition requiring immediate intervention"]
- [Example: "Patient's condition deteriorated rapidly, requiring urgent procedure to prevent serious harm"]
- [Example: "Provider reasonably believed service was covered without prior authorization per plan documents"]

[Continue with Medical Necessity Justification and rest of standard template]

[In Requested Action section:]

I respectfully request that [MA Plan name] overturn this denial and process payment for [service] provided on [date]. The claim amount is $[amount], and payment should be issued to [provider name, NPI] according to the member's benefit structure.

How to Submit Your Medicare Advantage Appeal

Proper submission is critical—missing deadlines or sending to the wrong address can forfeit your appeal rights.

Submission Methods by Plan

UnitedHealthcare Medicare Advantage:

• Online: UHC Provider Portal
• Fax: (Check your denial notice—varies by plan)
• Mail: UnitedHealthcare, P.O. Box 30778, Salt Lake City, UT 84130-0778
• Expedited: Call 1-877-842-3210

Humana Gold Plus:

• Online: provider.humana.com
• Fax: 888-556-2128
• Mail: P.O. Box 14165, Lexington, KY 40512-4165
• Expedited: 800-867-6601

Aetna Medicare Advantage:

• Online: Aetna Provider Portal
• Fax: (On denial notice)
• Mail: Aetna Medicare Appeals, P.O. Box 14463, Lexington, KY 40512-4463
• Expedited: Call number on denial notice

Blue Cross Blue Shield Medicare Advantage:

• Varies by state—check your specific BCBS MA plan
• Generally: Online portal, fax to number on denial, or mail to address on denial

What to Include in Your Submission Package

✅ Required Documents:

1. Completed appeal letter (using template)
2. Copy of the denial notice (organization determination)
3. Copy of original claim or prior authorization request
4. Clinical notes from relevant dates of service
5. Diagnostic test results supporting medical necessity
6. Physician's detailed letter explaining medical necessity

✅ Strongly Recommended:

• Failed treatment documentation (if applicable)
• Clinical practice guideline excerpts
• Peer-reviewed research supporting the intervention (if applicable)
• Specialist consultation notes
• Photos or imaging if relevant (e.g., wound care, dermatology)

✅ For Expedited Appeals, Also Include:

• Physician statement certifying urgency
• Documentation of rapid disease progression or severe symptoms
• Evidence that delay could cause serious harm

Common Mistakes That Destroy Medicare Advantage Appeals

Even clinically appropriate services get denied when appeals contain these errors:

❌ Missing the 65-Day Deadline This is an absolute deadline—extended from 60 days effective January 2025, but still strictly enforced. Late appeals get automatically rejected regardless of merit. Count from the date on the denial notice, not the date you received it.

❌ Generic "This Service is Necessary" Language Wrong: "Patient needs this procedure." Right: "Patient requires knee arthroscopy due to confirmed meniscal tear on MRI (performed 9/15/25) causing mechanical locking, pain level 8/10, and inability to bear weight. Conservative treatment with PT × 8 weeks and NSAIDs × 12 weeks provided insufficient relief. Procedure meets Medicare LCD L33822 criteria for surgical intervention."

❌ Failing to Address the Specific Denial Reason If the plan denied for "not medically necessary," don't argue that the service isn't experimental. Address exactly what they stated on the denial notice.

❌ No Objective Clinical Measurements Subjective statements like "patient is worse" don't persuade reviewers. Use objective measures: lab values, imaging findings, functional test scores, validated outcome measures (PHQ-9, VAS pain scale, ROM measurements).

❌ Missing Failed Treatment Documentation Many services require documented failure of conservative treatment first. If you tried medication/PT/other therapies before requesting the denied service, document it with:

• Specific medications/therapies with dates
• Dosages and duration
• Outcome (why it failed: insufficient relief, adverse effects, contraindication)

❌ Forgetting to Submit to the Right Plan If the patient has both Original Medicare and a Medicare Advantage plan, make absolutely sure you're appealing to the Medicare Advantage plan, not to the Medicare Administrative Contractor. The appeal processes are completely different.

How Muni Appeals Automates Medicare Advantage Appeals

Independent practices leave over $40,000 annually in denied Medicare Advantage claims unchallenged because manual appeals take 45-60 minutes. For a $150 denial, spending an hour of staff time (worth $60-90) doesn't make financial sense—so the denial goes unchallenged, even though it has an 82% chance of being overturned.

Muni Appeals changes the economics completely.

How It Works for Medicare Advantage

1. Upload Denial Notice (30 seconds) Photograph or upload your Medicare Advantage denial. Muni automatically extracts:

• Member Medicare number and MA plan ID
• Denial reason and code
• Service date and CPT codes
• 65-day appeal deadline (auto-calculated from denial date)

2. AI Compiles Appeal (4 minutes) Muni's AI assembles everything required for Medicare Advantage Level 1 appeals:

• Patient clinical data from your EMR
• Failed treatment timeline from prescription history
• Relevant Medicare NCDs/LCDs for the service
• MA plan-specific policy language (UHC, Humana, Aetna, BCBS)
• Clinical practice guideline citations
• Proper regulatory references (42 CFR citations)

3. Physician Review (1 minute) Review the compiled appeal for clinical accuracy. Add case-specific clinical judgment or context. Edit as needed.

4. Submit to MA Plan (Automated) Muni submits to the correct Medicare Advantage plan appeals department (UHC, Humana, Aetna, etc.) via the fastest method (fax, portal, or mail) and tracks the 30-day decision timeline.

5. IRE Escalation Tracking (Automatic) If the MA plan upholds the denial, Muni tracks the automatic IRE forwarding and monitors the Level 2 decision. You're notified when the IRE decision is issued.

Why Muni Wins More Medicare Advantage Appeals

65-Day Deadline Tracking: Muni calculates your exact deadline from the denial date and sends automatic reminders at 30 days, 14 days, and 3 days before expiration. Missing this deadline forfeits your appeal—Muni ensures it never happens.

Automatic IRE Monitoring: Most practices don't know when their Level 1 appeal was forwarded to IRE or when IRE decisions are issued. Muni tracks the entire process and alerts you at each stage.

MA Plan-Specific Policies: Every Medicare Advantage plan (UHC, Humana, Aetna, BCBS, Cigna) has slightly different coverage policies and appeal submission procedures. Muni automatically applies the correct plan-specific language and submission method.

NCD/LCD Citation: Muni references the relevant Medicare National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) for your MAC region, giving reviewers the exact Medicare coverage criteria framework.

Expedited vs Standard Detection: Muni helps you determine whether a case meets expedited review criteria and formats the appeal accordingly (72-hour vs 30-day language).

ROI for Practices with Medicare Advantage Patients

Manual Medicare Advantage Appeal:

• Time: 45-60 minutes per appeal
• Cost: $45-90 in staff/physician time
• Success rate: ~70% (baseline without specialized MA appeal knowledge)
• Economic threshold: Not worth appealing claims under $150

With Muni Appeals:

• Time: 5 minutes per appeal
• Cost: $5-7 in physician review time
• Success rate: 86% (Muni user data across all insurers)
• Economic threshold: Worth appealing any claim over $30

Annual Impact for Practice with 40% MA Patients:

• $800K in annual MA billings
• 5% denial rate = $40,000 denied
• Without appeals: Recover $0 (too time-intensive)
• With Muni Appeals: Recover $32,800 (95% of denials appealed × 86% success rate × 98% net of Muni cost)

Net revenue recovery: $32,000+ annually from Medicare Advantage denials alone

And this doesn't even count Level 2 IRE wins. Since MA plans automatically forward denied appeals to IRE, Muni users often win at Level 2 even when Level 1 fails—recovering additional revenue without any extra work.

Start 3 Free Appeals →

Frequently Asked Questions

How do I write a Medicare Advantage appeal letter?

To write a Medicare Advantage appeal letter: (1) Include your name, Medicare number, and MA plan member ID, (2) State the date of service and specific service/item denied, (3) Explain why you disagree with the denial using clinical evidence and medical necessity justification, (4) Reference Medicare NCDs/LCDs and clinical practice guidelines, (5) Attach supporting documentation (clinical notes, test results, physician letter), (6) Sign and date the letter. Submit within 65 days of the denial notice to your MA plan's appeals department. Use certified mail or fax with confirmation.

What is the deadline for Medicare Advantage appeals?

The deadline for Medicare Advantage Level 1 appeals is 65 days from the date on the denial notice. This deadline was extended from 60 days effective January 1, 2025. Count from the date printed on the denial notice, not the date you received it. Missing this deadline forfeits your appeal rights—there are very limited exceptions for late filing. For expedited appeals (when delay could harm health), you can request 72-hour review by calling your plan immediately, then submitting written documentation.

What is a Level 1 appeal for Medicare Advantage?

A Level 1 appeal for Medicare Advantage is called a "reconsideration" and is your first opportunity to challenge a denial. You submit your appeal directly to your Medicare Advantage plan (UnitedHealthcare, Humana, Aetna, etc.), and they review the original denial with any new evidence you provide. The plan has 30 days to decide standard appeals and 72 hours for expedited appeals. If they uphold the denial, your case automatically forwards to Level 2 (Independent Review Entity) for independent review—you don't need to take additional action.

What is an IRE appeal?

An IRE appeal (Independent Review Entity) is the Level 2 Medicare Advantage appeal conducted by MAXIMUS Federal Services, an independent contractor not affiliated with your MA plan. If your MA plan upholds a denial at Level 1, they automatically forward your case to the IRE within required timelines. The IRE conducts an independent review and decides within 30 days (standard) or 72 hours (expedited). IRE review is free—you don't pay anything. Approximately 35% of cases that reach IRE are overturned, even after the MA plan denied at Level 1.

Can I get an expedited Medicare Advantage appeal?

Yes. Expedited (fast-track) appeals are available when waiting for the standard 30-day review could seriously harm your life, health, or ability to regain maximum function. To request expedited review: (1) Call your MA plan immediately (number on your ID card) and explain the clinical urgency, (2) Submit written documentation within 48 hours explaining why delay poses health risk, (3) Your treating physician must support the expedited request. The plan must decide within 72 hours. Expedited appeals can be requested at both Level 1 (plan reconsideration) and Level 2 (IRE review).

What should I include in an MA appeal?

Include: (1) Completed appeal letter with member name, Medicare number, MA plan ID, and claim details, (2) Copy of the denial notice, (3) Clinical notes from relevant visits showing medical necessity, (4) Diagnostic test results (labs, imaging reports), (5) Treating physician's letter explaining why the service is medically necessary, (6) Documentation of failed conservative treatments (if applicable), (7) Clinical practice guideline excerpts supporting the intervention, (8) Medicare NCD/LCD citations if applicable. Organize documents chronologically with a cover letter explaining why the denial should be overturned.

How long does Medicare Advantage take to decide appeals?

Medicare Advantage appeal decision timelines: Level 1 (Plan Reconsideration) - 30 days for standard appeals, 72 hours for expedited appeals. Level 2 (IRE) - 30 days for standard, 72 hours for expedited (automatic forwarding from Level 1). Level 3 (ALJ) - Target 90 days (backlogs may extend this). Level 4 (Appeals Council) - Target 90 days. Level 5 (Federal Court) - Varies (months to years). Most MA appeals (90%+) resolve at Level 1 or Level 2 within 30-60 days total.

What happens if Level 1 appeal is denied?

If your Level 1 Medicare Advantage appeal is denied, your case automatically forwards to Level 2 (IRE) for independent review. You don't need to take any action—the MA plan is required by law to submit your case file to MAXIMUS (the IRE contractor) within specified timelines. The IRE conducts an independent review and decides within 30 days (standard) or 72 hours (expedited). You'll receive written notice from the IRE with their decision. If the IRE also denies and your claim is worth at least $190, you can request a Level 3 ALJ hearing within 60 days.

Can Muni Appeals automate Medicare Advantage appeals?

Yes. Muni Appeals specializes in Medicare Advantage appeals across all levels. Upload your MA denial, and Muni's AI compiles the Level 1 appeal in 5 minutes including: automatic 65-day deadline tracking, MA plan-specific policy citations (UHC, Humana, Aetna, BCBS), Medicare NCD/LCD references for your MAC region, clinical practice guideline integration, proper regulatory citations (42 CFR), expedited vs standard appeal formatting, and IRE escalation monitoring. Success rate: 86% vs ~70% baseline. Muni tracks automatic Level 2 IRE forwarding and notifies you of IRE decisions—recovering additional revenue even when Level 1 fails.

Should I appeal a denied MA claim even if it's small?

Traditionally no—manual MA appeals cost $45-90 in staff time, making small claims economically unviable. However, with automated tools like Muni Appeals (5-minute preparation), the economics transform. At $5-7 in review time, any MA claim over $30 becomes profitable to appeal given the 82% success rate. Additionally, many Level 1 denials win at Level 2 IRE (automatic forwarding), recovering claims that initially seemed lost. Finally, appealing establishes a pattern—MA plans are less likely to deny aggressively if they know you systematically challenge denials.

Ready to Recover Your Medicare Advantage Revenue?

Medicare Advantage denial rates have doubled since 2020, costing independent practices an average of $40,000+ annually in denied claims. 82% of these denials would be overturned if appealed—but only 11% ever get challenged because manual appeals aren't economically viable for most claim values.

Muni Appeals eliminates this problem entirely.

With Muni Appeals for Medicare Advantage, you get:

• ⚡ 5-minute Level 1 appeal generation (vs 45-60 minutes manual)
• 📅 Automatic 65-day deadline tracking with reminders
• 📈 86% success rate (vs ~70% baseline)
• 💰 $32,000+ average annual recovery from MA denials
• 🔄 Automatic Level 2 IRE escalation monitoring
• 🎯 MA plan-specific policy citations (UHC, Humana, Aetna, BCBS)
• 📋 Medicare NCD/LCD integration by MAC region
• ⚖️ Level 3-5 appeal support (ALJ, Council, Federal Court)

Independent practices using Muni Appeals recover an average of $32,000 annually in Medicare Advantage denials—revenue that was previously abandoned because manual appeals cost more in staff time than the claim value.

Start 3 Free Appeals and stop leaving Medicare Advantage revenue on the table.

---

This guide reflects 2025 Medicare Advantage appeal procedures and the 65-day filing deadline effective January 1, 2025. Medicare Advantage policies may vary by plan and state. Muni Appeals maintains current procedures for all major Medicare Advantage plans including UnitedHealthcare, Humana Gold Plus, Aetna Medicare, Blue Cross Blue Shield Medicare Advantage, and Cigna Medicare Advantage.