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Office of Medicare Hearings and Appeals (OMHA)

Tips for a Timely Review

This section covers only OMHA’s role at Level 3 of the appeals process.  The appeals process begins at Level 1. In order to appeal to OMHA, you must have passed through Level 1 and Level 2 of the appeals process.  For more information, see "Understanding the Appeals Process".

There are a number of things you can do to assist the processing of your request for a hearing.

  • Make sure your Request for Hearing is complete and accurate in order to minimize delays in obtaining your claim file from the QIC or prior decision-maker.
  • If you wish to appoint a representative, do so as early as possible.  Your representative will want time to review your file and prepare for the hearing. If you wait until the date of the hearing or shortly before, your hearing may have to be postponed to provide your representative with time to prepare. Rescheduling a hearing adds substantially to the time required to process your hearing request.  It may also extend the 90 day adjudication deadline.
  • Make sure that any evidence you want considered is submitted either with the Request for the ALJ hearing, or within 10 days of receiving the Notice of the ALJ hearing by either you or your representative.  If you are the provider/supplier, the authorized representative of the provider/supplier or are the provider/supplier appealing on behalf of the beneficiary, you must also include an explanation why the evidence was not previously submitted to the QIC or a prior decision-maker.  The ALJ will review the evidence and determine whether or not good cause exists for submitting the new evidence for the first time at the ALJ level.
  • Notify OMHA of any changes in your address immediately.
  • OMHA requests that you do not make automatic, multiple requests for the status of your request for ALJ hearing.

 


Content last reviewed on December 12, 2014