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Office of Medicare Hearings and Appeals (OMHA)

Text Only Version of Table: Entities Responsible for Medicare Appeals by Level and Medicare Part

Level of the Appeals ProcessMedicare Part A & BMedicare Part CMedicare Part D
Level 1Medicare Contractor
[see note at end of table]
Medicare Advantage PlanMedicare Prescription Drug Plan
Level 2QICIndependent Review EntityIndependent Review Entity
Level 3Office of Medicare Hearings and AppealsOffice of Medicare Hearings and AppealsOffice of Medicare Hearings and Appeals
Level 4Medicare Appeals CouncilMedicare Appeals Council Medicare Appeals Council
Level 5Federal CourtFederal CourtFederal Court

Medicare Contractor Note: In each part of the Medicare program, the Medicare contractor administering the program (usually an insurance company) makes a decision about your Medicare benefits.  In most cases, the decision is whether or not a medical service or item is covered and how much the Medicare program will pay for the service or item.  There are different names for these decisions depending on the part of the Medicare program covering the benefits. 

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