Office of Medicare Hearings and Appeals (OMHA)

You are reading about Level 2 of the appeals process.

Who to Appeal to for Level 2 Medicare Advantage Plans (Part C)

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You will be notified by mail of the outcome of your Level 1 appeal (called a reconsideration) for Medicare part C by your Medicare Advantage (Part C) plan. If you are dissatisfied with the outcome of the reconsideration, you may file a Level 2 appeal.

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.

After it has reviewed your case, the IRE will send you a notice of its decision in the mail. The notice will contain detailed information about your right to appeal to OMHA (Level 3) if you are dissatisfied with the IRE’s decision and the amount in controversy is $120 or more (in 2008).

For more information about filing a Level 2 appeal, visit the "Appeals and Grievance" section of Medicare.gov.

If your Level 2 appeal was not decided in your favor and you still disagree with the decision, you may file a Level 3 appeal with OMHA if the amount remaining in controversy is $120 or more (in 2008).

You can download the Chart of the Appeals Process for Those with Medicare Advantage - Part C [PDF - 56KB, DOC - 44KB]. The chart contains the overview for the entire appeals process for Medicare Advantage.

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.