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Level 4
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Office of Medicare Hearings and Appeals (OMHA)
Level 4 AppealsIf you are not satisfied with your Level 3 decision or dismissal, you may request that the Medicare Appeals Council (MAC) review the ALJ's decision. The Medicare Appeals Council (MAC): - 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 ALJs.
Note: A party does not have the right to seek MAC review of an ALJ's remand to a QIC or an ALJ's affirmation of a QIC's dismissal of a request for reconsideration. | Select any level for more information.
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A written request is required to obtain a MAC review. You may send a letter. For more information, see the MAC website.
Subject | Description |
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Required Information | Your request for review should include certain case identifying information, such as the: - Beneficiary's name;
- Name of the health services provider;
- Date and type of service;
- Medicare contractor or managed care organization that issued the initial determination in your case;
- Health Insurance Claim Number (HICN);
- OMHA appeal number;
- Date of the Administrative Law Judge (ALJ) decision or dismissal;
- An appointment of representative, such as CMS Form 1696 (PDF, 66.4 KB) (if applicable);
- Any additional evidence, clearly marked as new or duplicate; and
- Proof that you provided copies of your request to all other parties.
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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. Be sure to send a copy of your request to the organization that originally denied your claim (e.g., your HMO, health care provider, etc.). |
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Please note that the Office of Medicare Hearings and Appeals is responsible only for the Level 3 claims appeals and certain Medicare eligibility 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. |
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