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:

Topic	Description
Request an ALJ Hearing	Requirements for an Appeal How to Submit a Request for an appeal Setting Up Your ALJ Hearing Requesting an In-person Hearing Information on Video-Teleconferencing (VTC)
Your ALJ Hearing	What to Expect from the ALJ During the Hearing Canceling an ALJ Hearing
Documents for Your Hearing	Viewing your Current Case File Submitting New Evidence How OMHA Manages your Documents
After the ALJ Decision	How and When You Will be Notified of the Hearing Decision When the ALJ Issues a Decision Favorable to You When the ALJ Issues a Decision that is Not Favorable to You
Tips for a Timely Review	Things you can do to assist the processing of your request for hearing