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Level 3 Appeals (OMHA)

If you disagree with the outcome of your Level 2 appeal (called a reconsideration or reconsidered determination), you or your representative can request the dismissal or decision be reviewed by an OMHA adjudicator. 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). 
Review by an OMHA adjudicator gives you the opportunity to present your appeal to a new person who will independently review the facts of your appeal before making a new and impartial decision in accordance with the applicable law.
In some instances, an OMHA adjudicator may decide a case on the record (for example, if all the parties who would be sent a notice of hearing indicate in writing that they do not wish to appear at a hearing, or if the documentary evidence supports a finding fully favorable to the appellant(s) on every issue and no other party to the appeal is financially responsible for any of the claims at issue). Decisions, dismissals, and remands that do not require a hearing may be issued by an adjudicator.
Content created by Office of Medicare Hearings and Appeals (OMHA)
Content last reviewed on July 3, 2017