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OMHA Case Processing Manual (OCPM)


NOTE: OMHA is in the process of drafting new OCPM chapters and revising existing OCPM chapters to reflect changes to the manual’s format and organization. We are also making updates to address changes made by the Medicare appeals final rule that became effective March 20, 2017 (82 Fed. Reg. 4974 (Jan. 17, 2017)). You will find new and revised chapters posted here as they become available. For prior versions, refer to the 2017 Case Processing Manual. Please note that chapter numbering may have changed.

Chapter 1

Chapter Name Revision Updates Date
Manual Overview, Definition, and Governance Initial Release 5/25/2018

Chapter 2

Information Disclosure

Chapter 3

Adjudicators, Authorities, Burdens, and Standards of Review

Chapter 4

Chapter Name Revision Updates Date
Parties 03-29-2019 Initial Release 3/29/2019
Chapter 4 Parties material is undergoing Section 508 Review. Please contact OMHAPolicy@hhs.gov for assistance.

Chapter 5

Chapter Name Revision Updates Date
Representatives Initial Release 7/27/2018

Chapter 6

Chapter Name Revision Updates Date
CMS, CMS Contractor, and Plan Roles Initial Release 7/27/2018

Chapter 7

Chapter Name Revision Updates Date
Adjudication Time Frames, Case Prioritization, and Escalations 03-29-2019 7.4.3: Revised case prioritization policy to include inadvertently omitted language 3/29/2019
Adjudication Time Frames, Case Prioritization, and Escalations 07-27-2018 Initial Release 7/27/2018
Chapter 7 Adjudication Time Frames, Case Prioritization, and Escalations material is undergoing Section 508 Review. Please contact OMHAPolicy@hhs.gov for assistance.

Chapter 8

Special Case Processing Procedures

Chapter 9

Chapter Name Revision Updates Date
Request and Correspondence Intake, Docketing, and Assignment Initial Release 2/01/2019
Chapter 9 Request and Correspondence Intake, Docketing, and Assignment material is undergoing Section 508 Review. Please contact OMHAPolicy@hhs.gov for assistance.

Chapter 10

Party/Participant Requests and Submissions

Chapter 11

Procedural Screening (See 2017 Case Processing Manual)

Chapter 12

Administrative Record and Exhibiting (See 2017 Case Processing Manual)

Chapter 13

Issues on Appeal and Case Development

Chapter 14

Chapter Name Revision Updates Date
Scheduling and Noticing for Prehearing Conferences and Hearings Initial Release 9/28/2018

Chapter 15

Conducting Conferences and Hearings; Post-Hearing Development

Chapter 16

Decisions

Chapter 17

Chapter Name Revision Updates Date
Dismissals Initial Release 11/30/2018

Chapter 18

Chapter Name Revision Updates Date
Requests for Information and Remands Initial Release 11/30/2018

Chapter 19

Chapter Name Revision Updates Date
Closing the Case 03-29-2019 19.4.3, 19.5.1: Revised to clarify that if an adjudicator issues a consolidated decision, the adjudicator must also consolidate the record and combine the appeals in the case processing system 3/29/2019
Closing the Case 05-25-2018 Initial Release 5/25/2018
Chapter 19 Closing the Case material is undergoing Section 508 Review. Please contact OMHAPolicy@hhs.gov for assistance.

Chapter 20

Chapter Name Revision Updates Date
Post-Adjudication Actions Initial Release 5/25/2018

 

Content created by Office of Medicare Hearings and Appeals (OMHA)
Content last reviewed on March 29, 2019