What are the Medicare Appeals Council (MAC) and the Medicare Operations Division (MOD)?
The Medicare Operations Division (MOD) provides staff support to the Administrative Appeals Judges (AAJs) on the Medicare Appeals Council (MAC). The MAC provides the final administrative review of claims for entitlement to Medicare and individual claims for Medicare coverage and payment filed by beneficiaries or health care providers and suppliers. SSA makes the initial determination on claims for entitlement to Medicare. CMS contractors, including Medicare + Choice organizations, make initial determinations on individual claims for Medicare coverage and payment. On appeal, SSA ALJs provide a hearing. If dissatisfied with an ALJ hearing decision or dismissal, beneficiaries, health care providers and suppliers, or Medicare + Choice organizations may request MAC review or the MAC may undertake review at its discretion. The MAC may deny a request for review, or undertake review and issue a decision or dismissal or remand to an ALJ for further action. MAC decisions may be appealed to feder
