Office of Medicare Hearings and Appeals
Select any level for more information.
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).
Who Conducts Level 2 Appeals (e.g., "reconsidered determination")
An Independent Review Entity (IRE) retained by CMS, will conduct the Level 2 appeal, called a reconsidered determination in Medicare Part C. IREs have their own doctors and other health professionals to independently review and assess the medical necessity of the items and services pertaining to your case.
For more information about filing a Level 2 appeal, visit the "Appeals and Grievances" section of Medicare.gov.
Automatic Forward to Level 2 Appeals
Your Level 1 appeal ("reconsideration") will automatically be forwarded to Level 2 of the appeals process in the following instances:
Response to Your Appeal
After it has reviewed your case, the Independent Review Entity (IRE) will send you a notice of its decision in the mail.
Appealing to the Next Level of Appeals
The IRE notice will contain detailed information about your right to appeal to OMHA (Level 3). You may appeal to Level 3 in writing if:
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.