The Office of Medicare Hearings and Appeals (OMHA) administers the nationwide Administrative Law Judge (ALJ) hearing program for appeals arising from individual claims for Medicare coverage and payment for items and services furnished to beneficiaries (or enrollees) under Medicare Parts A, B, C and D. OMHA also hears appeals arising from claims for entitlement to Medicare benefits and disputes of Part B and Part D premium surcharges. OMHA generally conducts the third level of a five-level appeals process and operates separately from the other agencies involved in the Medicare claims appeal process.
OMHA has published a new chapter of the OMHA Case Processing Manual (OCPM). This manual standardizes the day-to-day procedures for carrying out adjudicative functions, in accordance with applicable statutes, regulations, and OMHA directives, and gives OMHA staff direction for processing appeals at the OMHA level of adjudication. As part of an ongoing effort to make the manual more user friendly and reflect regulatory changes, OMHA is in the process of drafting new OCPM chapters and revising existing chapters under a new format. Chapter 12, Administrative Record and Contents, was issued October 28, 2022.
New and revised OCPM chapters can be accessed
here.
Chapters published before May 10, 2018, are also
available.