This section covers only OMHA’s role at Level 3 of the appeals process.
The appeals process begins at Level 1
. In order to appeal to OMHA, you must have passed through Level 1
and Level 2
of the appeals process.
For more information, see "The Appeals Process."
Viewing your Current Case File
You and your representative may look at the evidence in your file. You do this by submitting the forms listed below.
For other options to view your records, visit the "Records, Record Change, and Information Requests" section of the Forms page.
Forms you need
If you are requesting your own record...
If you are a third party (e.g. representative, provider/supplier, etc.) requesting the record from OMHA...
Both of the following forms are needed:
Submitting New Evidence
Under certain circumstances, you may be able to submit new evidence.
Please submit any new evidence directly to the OMHA adjudicator assigned to review your appeal. When your request for hearing is assigned, OMHA will send you a Notice of Assignment with the name and address of the OMHA adjudicator assigned to your case. Please see http://www.hhs.gov/omha/important_notice_regarding_adjudication_timeframes.html
for further information regarding submitting new evidence.
If you are a provider, supplier, or beneficiary represented by a provider/supplier, your statement must also include an explanation why the evidence was not previously submitted to the QIC or a prior decision-maker. The OMHA adjudicator will examine any new evidence submitted to determine whether you had good cause for submitting the evidence for the first time at the OMHA level.
How OMHA Manages Your Documents
When your request for an ALJ hearing is received by the OMHA field office, the staff establishes an electronic record to keep track of your case. The staff also sends a request to the QIC or other lower level decision-maker for them to forward your claim file to OMHA. An accurately completed request for ALJ hearing minimizes delays in obtaining your claim file.