Office of Medicare Hearings and Appeals
Level 2 Appeals: Original Medicare (Parts A & B)
The Level 2 claim appeals process differs based on what Part of Medicare you want to appeal.
The tabs below describe what the claim appeals process is for each of the four different kinds of Medicare coverage (Parts A, B, C, and D).
Select any level for more information.
You may request a Level 2 appeal if you are not satisfied with the outcome of your Level 1 appeal (called a redetermination for Medicare Parts A&B).
|Who Conducts Level 2 Appeals|
A Qualified Independent Contractor (QIC), retained by CMS, will conduct the Level 2 appeal, called a reconsideration in Medicare Parts A & B. QICs have their own physicians and other health professionals to independently review and assess the medical necessity of the items and services pertaining to your case.
|Time Limit for Filing a Level 2 Appeal|
You may file for a Level 2 appeal within 180 days of receiving the written notice of redetermination, which affirms the initial determination in whole or in part.
Request for Level 2 Appeal
(i.e., "request for reconsideration")
To request a reconsideration, follow the instructions on your notice of redetermination. Your written request for reconsideration must include:
- The Medicare Health Insurance Claim (HIC) number;
- The specific service(s) and/or item(s) for which the reconsideration is requested;
- The specific date(s) of service;
- Your name;
- The name and signature of your representative, or your own name and signature if you have not authorized or appointed a representative;
- The name of the organization that made the redetermination; and
- A copy of the notice of redetermination.
In addition to your request, you should:
- Explain why you disagree with the initial determination, including the Level 1 notice of redetermination; and
- Enclose any other information you want the QIC to review with your request. Additional material submitted after the request has been filed may delay the decision.
Your written request and materials should be sent to the QIC identified in the notice of redetermination.
|Submitting Additional Evidence|
The QIC can only consider information it receives prior to reaching its decision.
Please submit all documents you think will support your case.
It will be more difficult to submit new evidence later.
Submitting new evidence at the next level of appeal, Level 3, may require explanation of good cause for submitting evidence for the first time at Level 3.
|When You Will Get a Decision|
Reconsiderations are conducted on-the-record and, in most cases, the QIC will send you a notice of its decision within 60 days of receiving your Medicare Part A or B request.
- The notice will contain detailed information about your right to appeal to OMHA (Level 3) if you are dissatisfied with the QIC’s decision.
- If the QIC is unable to make its decision within the required time frame, they will inform you of your right to escalate your appeal to OMHA.
|Special Circumstances for Expedited Review||You may request an expedited reconsideration in Medicare Parts A & B if you are dissatisfied with a Quality Improvement Organization's (QIO's) expedited determination at Level 1. Expedited reconsiderations are conducted by Qualified Independent Contractors (QICs).|
To request an expedited reconsideration at Level 2, you must submit a request to the appropriate QIC no later than noon of the calendar day following your notification of the Level 1 decision. In most cases, the QIC will notify you of its decision on the reconsideration within 72 hours of receiving your request.
|Appealing to the Next Level of Appeals|
If your Level 2 appeal was not decided in your favor and you still disagree with the decision, you may file a Level 3 appeal with OMHA if the remaining amount in controversy is $130 or more (in 2012).
For more information about filing a Level 2 appeal, visit the "Appeals and Grievances" section of Medicare.gov.
Please note that the Office of Medicare Hearings and Appeals is responsible only for the Level 3 claims appeals and certain Medicare entitlement and Part B premium appeals. OMHA is not responsible for levels 1, 2, 4, and 5 of the appeals process. OMHA provides additional information on other levels of appeals to help you understand the appeals process in a broad context.