If you are not satisfied with your Level 3 decision or dismissal, you may request that the Medicare Appeals Council (Council) review OMHA's decision.
The Council:
- Conducts the Level 4 appeal, and is
- Part of the Departmental Appeals Board of the Department of Health and Human Services (HHS), and is
- Independent of OMHA and its adjudicators.
Note: A party does not have the right to seek Council review of an OMHA adjudicator's remand to a QIC, dismissal of a request for review of a reconsideration dismissal, or affirmation of a QIC's dismissal of a request for reconsideration.
How to request a Medicare Appeals Council (Council) Review
A written request is required to obtain a Council review. You may send a letter or file electronically. For more information on how to file and what case identifying information is required, see the Council website.
Submitting your request
You may mail your request to:
Department of Health and Human Services
Departmental Appeals Board, MS 6127
Medicare Appeals Council
330 Independence Avenue, SW, Room G-644
Washington DC 20201
You may also fax your request for review to (202) 565-0227.
Please note that the Office of Medicare Hearings and Appeals is responsible only for the Level 3 claims appeals and certain Medicare entitlement appeals 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.
