Skip Navigation

Office of Medicare Hearings and Appeals (OMHA)

Five Levels of the Medicare Appeals Process

There are five levels in the Medicare claims appeal process.  OMHA is responsible for Level 3 claims appeals.  Click below or to the left to learn more about each level:

OMHA appeals process as a series of five levels with a description of each level.

Level 5: Federal Court. If you disagree with the Medicare Appeals Council decision, you may seek a review of your claim in Federal District Court.Level 4: The Medicare Appeals Council. If you disagree with the Administrative Law Judge's decision, you may request the Medicare Appeals Council review the decision.Level 3: Office of Medicare Hearings & Appeals (OMHA). If you disagree with the Level 2 decision, you may request that OMHA review your claim through an Administrative Law Judge. Level 2: An Independent Organization. If you disagree with the decision in Level 1, you may request a reconsideration by an independent organization.Level 1: Your Health Plan. If you disagree with a Medicare coverage decision, you may request your health plan to redetermine your claim.

You can visit the charts page for charts detailing the entire appeals process by type of Medicare. 

Please note that the Office of Medicare Hearings and Appeals is responsible only for the Level 3 claims appeals and certain Medicare entitlements and IRMAA 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.