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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 (MAC), 90 days after you file a complete request for hearing. More information on escalating a request for hearing can be found at 42 C.F.R. sections 405.1104 and 405.1106(b). When a request for hearing is escalated, the MAC may take any action in accordance with 42 C.F.R. section 405.1108(d), but is not required to conduct a hearing.

Escalating a request for hearing is a two-step process. See In re General Medicine, P.C. (MAC Sep. 6, 2007). To initiate the process, you must file a written request for escalation with OMHA. If your request has been assigned to an Administrative Law Judge, please file your request with the Administrative Law Judge’s field office. Please clearly indicate your submission as an escalation request to help us process your request as quickly as possible. Our field office addresses can be found at http://www.hhs.gov/omha/contacts/offices.html.

If your request has not been assigned to an Administrative Law Judge, please file your request for escalation with:

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

After OMHA receives your initial request for escalation, you may receive a decision, dismissal, remand order, or a Notice on Escalation Request. However, if you do not hear from us within 10 days (including 5 days for mailing time), you may consider your request escalated and proceed to seek MAC review of the escalated request. The request for MAC review must:

  • Contain the required content for a request for review of an escalated case set forth in 42 C.F.R. section 405.1112; 
  • Be sent to both the MAC and the Administrative Law Judge’s OMHA office (or OMHA Central Operations if you sent your request for escalation there); and 
  • Be copied to the other parties to the appeal (for example, the parties who received a copy of the Notice of Reconsideration).

The address for the MAC is:

Department of Health and Human Services
Departmental Appeals Board, MS 6127
Medicare Appeals Council
Attn: Escalation Mailstop
330 Independence Ave., S.W.
Cohen Building, Room G-644
Washington, D.C. 20201

Please note that if you do not request MAC review of an escalated request, the case will remain pending with OMHA and the Administrative Law Judge adjudication process will continue.

Content created by Office of Medicare Hearings and Appeals (OMHA)
Content last reviewed on August 10, 2016