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\nWho Conducts Level 2 Appeals
\nA Qualified Independent Contractor (QIC), retained by CMS, will conduct the Level 2 appeal, called a reconsideration in Medicare Parts A & B. QICs have their own physicians and other health professionals to independently review and assess the medical necessity of the items and services pertaining to your case.
\nTime Limit for Filing a Level 2 Appeal
\nYou may file for a Level 2 appeal within 180 days of receiving the written notice of redetermination, which affirms the initial determination in whole or in part.
\nRequest for Level 2 Appeal (i.e., \"request for reconsideration\")
\nTo request a reconsideration, follow the instructions on your notice of redetermination. Your written request for reconsideration must include:
\nIn addition to your request, you should:
\nYour written request and materials should be sent to the QIC identified in the notice of redetermination.
\nSubmitting Additional Evidence
\nThe QIC can only consider information it receives prior to reaching its decision.
\nWhen You Will Get a Decision
\nReconsiderations are conducted on-the-record and, in most cases, the QIC will send you a notice of its decision within 60 days of receiving your Medicare Part A or B request.
\nSpecial Circumstances for Expedited Review
\nYou may request an expedited reconsideration in Medicare Parts A & B if you are dissatisfied with a Quality Improvement Organization's (QIO's) expedited determination at Level 1. Expedited reconsiderations are conducted by Qualified Independent Contractors (QICs).
\nTo request an expedited reconsideration at Level 2, you must submit a request to the appropriate QIC no later than noon of the calendar day following your notification of the Level 1 decision. In most cases, the QIC will notify you of its decision on the reconsideration within 72 hours of receiving your request.
\nAppealing to the Next Level of Appeals
\nIf 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 you meet the minimum amount in controversy.
\nFor more information about filing a Level 2 appeal, visit the \"Claims & Appeals\" section of Medicare.gov.
\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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