Filing an Appeal
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.
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.
Coverage and Claims Appeals
Find out how to file an appeal if you were denied coverage for part or all of a medical service that you believe should have been covered by Medicare.
Your Right to Representation
Learn how to appoint someone to represent you and make requests, present or elicit evidence, or receive notice about your appeal.
Appeals Status Lookup
Check the status of your appeal using the ALJ Appeal Status Information System (AASIS).
Forms
Find the forms necessary to filing a Medicare claim appeal with OMHA.
