An initial determination is a decision made by CMS' RDS Center in response to information that the Plan Sponsor submitted. If a Plan Sponsor disagrees with the initial determination made by CMS' RDS Center, it can submit a reconsideration request. The following are the two types of initial determinations for which a Plan Sponsor may submit a reconsideration request using the RDS Secure Website: Did not meet the Application Deadline and Reconciliation Final Payment.
There are 3 levels of reconsideration appeals:
- First level: Reconsideration
- Second level: Informal Hearing
- Third level: Administrator Review
The second and third levels of reconsideration-related appeals are not requested using the RDS Secure Website. Plan Sponsors receive instructions regarding how to request additional level of appeals once a first level appeal decision is made by CMS' RDS Center.