The Office of Medicare Hearings and Appeals (OMHA) is responsible for Level 3 of the Medicare claims appeal process; certain Medicare entitlement appeals; Part B and Part D premium appeals.
OMHA was created by the Medicare Modernization Act of 2003 to simplify the appeals process and make it more efficient. During an appeal, an OMHA Administrative Law Judge or attorney adjudicator conducts a new ("de novo") review of an appellant's case and issues a decision based on the facts and the law.
The Chief Administrative Law Judge leads the entire agency, which consists of six field offices and a headquarters office. Each field office includes many Administrative Law Judges and attorney adjudicators who are overseen by an Associate Chief Administrative Law Judge. Appeals are assigned to these adjudicators by a Centralized Dockting Division in accordance with standardized procedures.
Contact information for each OMHA field office is available.
Workload Information and Statistics
Find data about OMHA’s current workload, including decision statistics and average processing time.
Learn how OMHA is working to improve the Medicare appeals process through pilot programs and other special initiatives.
Information about the Medicare Appeals Backlog
Learn the basics about the Medicare Appeals process and the current backlog in “HHS Primer: The Medicare Appeals Process” (PDF - 521 KB)