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 "The Appeals Process."
At Level 3 of the appeals process, your appeal will be reviewed by an OMHA adjudicator, and you may have a hearing before an Administrative Law Judge (ALJ). This gives you the opportunity to present your appeal to a new person who will independently review the facts of your appeal and make a new and impartial decision in accordance with the applicable law. If you have a hearing before an OMHA ALJ, the ALJ will also listen to your testimony before making a decision in accordance with the applicable law.
In some instances, an OMHA adjudicator may decide a case on the record if all parties who would be sent a notice of hearing waive their rights to an oral hearing or when the documentary evidence supports a finding fully favorable to the appellant, and no other party to the appeal would be financially responsible for any of the claims at issue.
Medicare Beneficiary and Medicare Advantage Part C Plan Enrollee or Part D Plan Enrollee Appeals and Assistance
To help ensure Medicare Beneficiary and Enrollee appeals are adjudicated as quickly as possible, OMHA designates appeals filed by Beneficiaries and Enrollees as priority appeals, with some exceptions.Learn more about appeals and assistance.
In this section of the web site, you will find the following:
| Topic | Description |
|---|---|
| Request an ALJ Hearing |
|
| Tips for Filing a Request for ALJ Hearing or Review of Dismissal |
|
| Your ALJ Hearing |
|
| Documents for Your Hearing |
|
| After the OMHA Adjudicator's Decision, Remand, or Dismissal |
|