Medicare Claims Processing Manual (Pub. 100-04), Ch. 34 § 10.6.3
Timeframes for Adjudicator to Reopen
10.6.3 - Timeframes for Adjudicator to Reopen
(Rev. 3568, Issued: 07-29-16, Effective: 09-30-16, Implementation: 09-30-16)A
QIC, ALJ or the AC may reopen and revise its reconsideration, hearing decision or
review, respectively, under the following conditions:
• Within 180 days from the date of its decision for good cause in accordance with
42 CFR 405.986; or,
• At any time if the reconsideration, hearing decision or review was procured by
fraud or similar fault.