Tuesday, January 31, 2017

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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