Content created by Office of Medicare Hearings and Appeals (OMHA)
The Office of Medicare Hearings and Appeals (OMHA) is in charge of Level 3 of the Medicare appeals process. In order to appeal to OMHA, you must have passed through Level 1 and Level 2 of the appeals process. Click here for details on filing an appeal online through the OMHA e-Appeal Portal or by mail. Please note, the portal cannot accept appeal requests for Part A QIO (Quality Improvement Organization) appeals (such as Kepro or Livanta), Social Security Administration appeals, Medicare Secondary Payer appeals, Medicare Part C (Medicare Advantage) appeals, and Medicare Part D appeals at this time. Forms needed for your appeal are located here.
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 is financiallly responsible for any of the claims at issue.