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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:

TopicDescription
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