Level 3 Appeals (OMHA)
If you disagree with the outcome of your Level 2 appeal (called a reconsideration in Parts A & B/Original Medicare, and D/Prescription Drug Plan and a reconsidered determination in Part C/Medicare Advantage), you or your representative can request a hearing before an OMHA Administrative Law Judge (ALJ). This is Level 3 of the claims appeal process.
A hearing before an OMHA ALJ gives you the opportunity to present your appeal to a new person who will independently review the facts of your appeal and listen to your testimony before making a new and impartial decision in accordance with the applicable law.
In some instances, an OMHA ALJ may decide a case on-the-record if a party waives its rights to an oral hearing or when the documentary evidence supports a finding fully favorable to the appellant(s).