Scanning sources…acquiring signal · establishing uplink
Establishes the Medicare program (Parts A, B, C, D). Coverage predicated on §1862(a)(1)(A) 'reasonable and necessary' standard.
{
"prompt_pay": {
"clean_claim_days": null,
"interest_rate_apr": null,
"penalty_per_day_cents": null
},
"appeal_levels": [
{
"name": "Redetermination",
"level": 1,
"filing_days": 120,
"decision_days": 60
},
{
"name": "Reconsideration (QIC)",
"level": 2,
"filing_days": 180,
"decision_days": 60
},
{
"name": "ALJ Hearing",
"level": 3,
"filing_days": 60,
"threshold_amount_cents": 18000
},
{
"name": "Medicare Appeals Council",
"level": 4,
"filing_days": 60
},
{
"name": "Federal District Court",
"level": 5,
"filing_days": 60,
"threshold_amount_cents": 180000
}
],
"network_adequacy": {
"max_miles_primary": null,
"max_miles_specialty": null,
"max_wait_days_primary": null
},
"cost_sharing_caps": {
"family_max_oop_cents": null,
"individual_max_oop_cents": null
},
"timely_filing_windows": {
"appeal_days": null,
"cob_secondary_days": null,
"initial_claim_days": null,
"corrected_claim_days": null,
"reconsideration_days": null
}
}