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Escalation Rights

If you are appealing a Part A or Part B reconsideration issued by a Qualified Independent Contractor (QIC), you may have a right to escalate your request for hearing to the Medicare Appeals Council (Council) if 90 calendar days have passed since you filed your complete request for hearing and your appeal remains pending with OMHA. (Please note, however, that certain events may extend the 90 calendar day adjudication period.) More information on escalating a request for hearing can be found at 42 C.F.R. sections 405.1016(f) and 405.1106(b). When a request for hearing is escalated, the Council may take any action in accordance with 42 C.F.R. section 405.1108(d), but is not required to conduct a hearing.

To initiate the escalation process, you must file a written request for escalation with OMHA, and copies of the request for escalation must also be sent to all the other parties who were sent a copy of the QIC notice of reconsideration.

If your request has been assigned to an OMHA adjudicator, please send your written request to that adjudicator (visit http://www.hhs.gov/omha and use the appeal status lookup tool to find your assigned adjudicator).

If your request has not been assigned to an OMHA adjudicator, please file your request for escalation with:

OMHA — Central Operations
Attn: Escalation Request Mail Stop
200 Public Square, Suite 1260
Cleveland, OH 44114

After OMHA receives a valid request for escalation, you will receive a decision, dismissal, or remand order if an OMHA adjudicator is able to issue one within 5 calendar days of receiving the request for escalation, or 5 calendar days from the end of the applicable adjudication period (whichever is later). Otherwise, OMHA will forward the case file to the Council and send you a notice stating that the appeal has been escalated.

 

 

Content created by Office of Medicare Hearings and Appeals (OMHA)
Content last reviewed on March 29, 2017