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: