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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

Parties (See 2017 Case Processing Manual)

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 Initial Release 7/27/2018

Chapter 8

Special Case Processing Procedures

Chapter 9

Request Intake/Docketing and Assignment (See 2017 Case Processing Manual)

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

Scheduling and Noticing for Conferences and Hearings (See 2017 Case Processing Manual)

Chapter 15

Conducting Conferences and Hearings; Post-Hearing Development

Chapter 16

Decisions

Chapter 17

Dismissals

Chapter 18

Remands

Chapter 19

Chapter Name Revision Updates Date
Closing the Case Initial Release 5/25/2018

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 May 25, 2018