Office of Medicare Hearings and Appeals (OMHA)
Coverage and Claims Appeals
OMHA is in charge of Level 3 of the coverage and claims appeals process. 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".
At Level 3 of the appeals process, you may have a hearing before an OMHA ALJ. This gives you the opportunity to present your appeal to a new person who will independently review the facts of your appeal and listen to your testimony before making a new and impartial decision in accordance with the applicable law.
In some instances, an OMHA ALJ may decide a case on-the-record if all parties waive their rights to an oral hearing or when the documentary evidence supports a finding fully favorable to the appellant.
In this section of the web site, you will find the following:
|Request an ALJ Hearing|
|Your ALJ Hearing|
|Documents for Your Hearing|
|After the ALJ Decision|
|Tips for a Timely Review|