Skip to main content


U.S. flag
      An official website of the United States government
              Here’s how you know
        Here’s how you knowDot gov**Official websites use .gov**
                 A **.gov** website belongs to an official government organization in the United States.
                  HTTPS**Secure .gov websites use HTTPS**
                 A **lock** (A locked padlock) or **https://** means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites. 
  Menu Close
          Enter the terms you wish to search for.
    Search
        








  
  
    

  
      

                                      About HHS
    
                        
                              
      
      
      Programs & Services
    
                        
                              
      
      
      Grants & Contracts
    
                        
                              
      
      
      Laws & Regulations Breadcrumb
    Home
                              About
                              Agencies
                              OMHA
                              Filing An Appeal
                              Coverage and Claims Appeals
 Navigate to:
  Office of Medicare Hearings and Appeals (OMHA)
    
                                                  
                                                                  
            
      
      
      
      The Appeals Process
                                            
            
            Level 1 Appeals
    
                                                  
                                            
            
      
      
      
      Level 2 Appeals
    
                                                  
                                            
            
      
      
      
      Level 3 Appeals (OMHA)
    
                                                  
                                            
            
      
      
      
      Level 4 Appeals
    
                                                  
                                            
            
      
      
      
      Level 5 Appeals
    
                                                  
                                            
            
      
      
      
      Legal Authorities
    
                                                  
                                            
            
      
      
      
      Case Processing Manual
    
                                                  
                                                                                        
                          
      
      
      
      Filing an Appeal
                                            
            
            Coverage and Claims Appeals
                          
            
            Medicare Beneficiary and Enrollee Appeals and Assistance
    
                                                  
                                            
            
      
      
      
      Escalation Rights
    
                                                  
                                            
            
      
      
      
      Your Right to Representation
    
                                                  
                                            
            
      
      
      
      Appeals Status Lookup
    
                                                  
                                            
            
      
      
      
      Forms
    
                                                  
                                            
            
      
      
      
      Glossary
    
                                                  
                                            
            
      
      
      
      FAQs
    
                                                  
                                                                  
            
      
      
      
      About OMHA
                                            
            
            Organizational Chart
                          
            
            Leadership
    
                                                  
                                            
            
      
      
      
      Workload Information and Statistics
    
                                    
                                            
            
      
      
      
      Contact OMHA
    
                                    
                                            
            
      
      
      
      Work for Us
    
                                    
                                            
            
      
      
      
      Whistleblower Protections and Non-Disclosure Agreements
    
                                    
                                            
            
      
      
      
      Notice of Non-DiscriminationText resize icon

                    




Coverage and Claims Appeals








  
  
    

  
      



OMHA is in charge of Level 3 of the coverage and claims appeals process.  In order to appeal to OMHA, you must have passed through Level 1 and Level 2 of the appeals process.  For more information, see "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 would be financially responsible for any of the claims at issue.

Medicare Beneficiary and Medicare Advantage Part C Plan Enrollee or Part D Plan Enrollee Appeals and Assistance
 

To help ensure Medicare Beneficiary and Enrollee appeals are adjudicated as quickly as possible, OMHA designates appeals filed by Beneficiaries and Enrollees as priority appeals, with some exceptions.Learn more about appeals and assistance.

In this section of the web site, you will find the following:

Topic
			Description**Request an ALJ Hearing**
			Requirements for an Appeal
				How to Submit a Request for an appeal
				Setting Up Your ALJ Hearing
				Requesting an In-person Hearing
				Information on Video-Teleconferencing (VTC)**Tips for Filing a Request for ALJ Hearing or Review of Dismissal**
			Where to File
				What Information to Include
				Filing Time Frame
				Multiple Beneficiaries
				Grouping Multiple Requests for Hearing
				Aggregating Claims to Meet the Amount in Controversy
				Withdrawing a Request for Hearing or Review of a Dismissal**Your ALJ Hearing**
			What to Expect from the ALJ During the Hearing
				Canceling an ALJ Hearing**Documents for Your Hearing**
			Form to Request a Copy of the Records in the Case File
				Form to Submit New Evidence
				Form to Waive your Right to an ALJ Hearing**After the OMHA Adjudicator's Decision, Remand, or Dismissal**
			How and When You Will be Notified of the OMHA adjudicator's Determination on your Appeal
				When the OMHA adjudicator Makes a Determination that is Favorable to You
				When the OMHA adjudicator Makes a Determination that is Not Favorable to You

                    
  


Content created by Office of Medicare Hearings and Appeals (OMHA) Content last reviewed September 26, 2023 Back to top
    Contact HHS
    
                        
                                            
      
      
      Careers
    
                        
                                            
      
      
      HHS FAQs
    
                        
                                            
      
      
      Nondiscrimination NoticeHHS Archive
    
                        
                                            
      
      
      Accessibility Statement
    
                        
                                            
      
      
      Privacy Policy
    
                        
                                            
      
      
      Viewers & PlayersBudget/Performance
    
                        
                                            
      
      
      Inspector General
    
                        
                                            
      
      
      Web Site Disclaimers
    
                        
                                            
      
      
      EEO/No Fear ActFOIA
    
                        
                                            
      
      
      The White House
    
                        
                                            
      
      
      USA.gov
    
                        
                                            
      
      
      Vulnerability Disclosure Policy
        Sign Up for Email Updates

Receive the latest updates from the Secretary, Blogs, and News Releases.

Sign Up
  HHS Headquarters
          200 Independence Avenue, S.W.
                  Washington, D.C. 20201
                  Toll Free Call Center: 1-877-696-6775​