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There are five levels in the Medicare Part A and Part B appeals process.

The levels are:

  1. First Level of Appeal:        Redetermination by a Medicare Administrative Contractor (MAC)
  2. Second Level of Appeal:   Reconsideration by a Qualified Independent Contractor (QIC)
  3. Third Level of Appeal:       Decision by the Office of Medicare Hearings and Appeals (OMHA)
  4. Fourth Level of Appeal:     Review by the Medicare Appeals Council
  5. Fifth Level of Appeal:        Judicial Review in Federal District Court

Did You Know that HHS/OIG Found
When beneficiaries and providers appealed preauthorization and payment denials, Medicare Advantage Organizations (MAOs) overturned
75 percent of their own denials

We help Providers successfully navigate the appeals process without disrupting all other business

workflows while assuring they receive all entitled reimbursement and due process

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