New Forms for ALJ Hearings or Review of Dismissals

Dianne De La Mare

The US Department of Health and Human Services, Office of Medicare Hearings and Appeals (OMHA) has introduced a new unified Request for Administrative Law Judge (ALJ) Hearing or Review of Dismissal form (OMHA-100) to replace the current Request for ALJ Hearing form (CMS-2003A/B) and Request for Review of Dismissal form (HHS-725).
Specifically, the OMHA-100 form can be used to request an ALJ hearing or a review of dismissal for all actions that are appealable to OMHA, including appeals of Medicare Parts A and B claim reconsiderations issued by a Qualified Independent Contractor (QIC) or Quality Improvement Organization (QIO), and Part D coverage reconsiderations issued by an Independent Review Entity (e.g., the Part D QIC).
The parties or their representatives, however, must follow the appeal instructions that come with a notice of reconsideration or dismissal for specific instructions on how to appeal the reconsideration or dismissal, and where to send a request for an ALJ hearing or review of dismissal. Further, an accompanying Multiple Claim Attachment (OMHA-100A) can be used to identify multiple beneficiaries or enrollees associated with a single request.

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