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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. 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.

                    
  


Content created by Office of Medicare Hearings and Appeals (OMHA) Content last reviewed December 8, 2021 Back to top
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