The US Department of Health & Human Services’ Office of Medicare Hearings and Appeals (“OMHA”) administers appeal hearings for the Medicare program.

There are five levels in the Medicare claims appeal process.  OMHA’s Administrative Law Judges (“ALJs”) hold hearings and issue decisions related to Medicare coverage determinations that reach level three of the Medicare claims appeal process.

OMHA’s Chief ALJ Nancy J. Griswold explained in a memorandum that due to the rapid increase in claim appeals, effective July 15, 2013, OMHA has temporarily suspended the assignment of most new requests for an ALJ hearing in order to enable OMHA to reduce its backlog of pending ALJ appeals.

The suspension applies to Medicare providers and suppliers, and State Medicaid agencies, but not to appeals filed directly by Medicare beneficiaries.  Judge Griswold indicated that OMHA expects this suspension to last at least two years.  Further information and updates on OMHA’s adjudication timeframes are available on the OMHA website.

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