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\nThe Level 2 claim appeals process differs based on what Part of Medicare you want to appeal. If you are dissatisfied with the outcome of your Level 1 appeal (called a redetermination in Medicare Part D), you may file a Level 2 appeal. The Level 2 appeal is called a \"reconsideration\".
\nWho Conducts Level 2 Appeals
\nTime Limit for Filing a Level 2 Appeal (e.g., \"Request for a reconsideration\")
\nFor more information about filing a Level 2 appeal, visit the \"Claims & Appeals\" section of Medicare.gov.
\nWhen you Will Get a Response to Your Appeal
\nSpecial Circumstances
\nYou may request an expedited reconsideration for Part D coverage decisions. Your request will be expedited if the Independent Review Entity (IRE) determines or your doctor tells the IRE that your life or health will be seriously jeopardized by waiting for a standard decision. If your request is expedited, the IRE has 72 hours to notify you of its decision.
\nAppealing to the Next Level of Appeals
\nIf your Level 2 appeal was not decided in your favor and you disagree with the decision, you may file a Level 3 appeal with OMHA if the remaining amount in controversy is $170 or more (2020). Note you may be able to combine claims to meet the minimum dollar amount. You have 60 days after receiving the Level 2 decision to request a Level 3 hearing in writing.
\nPlease 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.
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