Aggregation of Claims to Meet the Amount in Controversy

250.3 - Aggregation of Claims to Meet the Amount in Controversy (Rev. 4278, Issued: 04-12-19, Effective: 06-13-19, Implementation: 06-13-19) A party appealing a QIC reconsideration to the ALJ level that does not meet the AIC threshold requirements may, under certain circumstances, aggregate claims to meet the requirements set forth in 42 CFR 405.1006. Either an individual appellant or multiple appellants may aggregate two or more claims to meet the AIC requirements for an ALJ hearing if - a) The claims were previously reconsidered by a QIC; b) The request for ALJ hearing lists all of the claims to be aggregated and is filed within 60 days after receipt of all the reconsiderations being appealed; and c) The ALJ determines that the claims that a single appellant seeks to aggregate involve the delivery of similar or related services, or the claims that multiple appellants seek to aggregate involve common issues of law and fact. Part A and Part B claims may be combined to meet the AIC requirements. In cases where claims are escalated from the QIC level to the ALJ level (if parties have met all other requirements), aggregating claims may proceed under certain circumstances. Either an individual appellant or multiple appellants may aggregate two or more claims to meet the AIC for an ALJ hearing if - (a) The claims were pending before the QIC in conjunction with the same request for reconsideration; (b) The appellant(s) requests aggregation of the claims to the ALJ level in the same request for escalation; and (c) The ALJ determines that the claims that a single appellant seeks to aggregate involve the delivery of similar or related services, or the claims that multiple appellants seek to aggregate involve common issues of law and fact. Part A and Part B claims may be combined to meet the AIC requirements. When the appellant(s) seeks to aggregate claims in a request for an ALJ hearing, the appellant(s) must- (a) Specify all of the claims the appellant(s) seeks to aggregate; and (b) State why the appellant(s) believes that the claims involve common issues of law and fact or delivery of similar or related services.