In the Medicare appeal process, which entity handles the initial redetermination?

• A. Administrative Law Judge (ALJ)
• B. Medicare Administrative Contractor (MAC)
• C. Qualified Independent Contractor (QIC)
• D. Centers for Medicare & Medicaid Services (CMS)

Answer: (B)

The main idea here is how Medicare routes the first level of appeal. The initial redetermination is handled by the Medicare Administrative Contractor, or MAC. These are CMS-contracted agencies that process claims and perform the first formal review when a claim denial is appealed. If you still disagree after the MAC’s redetermination, you move on to the next level, which is reconsideration by a Qualified Independent Contractor. The Administrative Law Judge handles the next stage after reconsideration, and CMS is the federal agency that oversees the program but doesn’t perform the initial redetermination itself.