- Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)
- Tip Sheet for Medicare Providers on First Level of Appeals (Redeterminations)
- Five Levels of Appeals
- Request a Redetermination
- Request a Redetermination
- Request a Redetermination
- Request a Redetermination
- Submit a Reconsideration
- Submit a Reconsideration
- ALJ Hearing
- Medicare Appeals Council Review
- Federal Court Review
ALJ Hearing
The third level of appeal is an ALJ hearing.
- Time limit to initiate = 60 days from the date of receipt of reconsideration (QIC decision)
- Time limit to complete the review = 90 days
- Amount in controversy = $180 (effective 1/1/2024)
- Note: The amount in controversy for CY 2023 remains at $180. This amount will remain at $180 for ALJ hearing requests filed on or after 1/1/2024.
Your request must specifically state that an ALJ hearing is desired and the request must be signed.
For complete details on the content required for a request for a hearing, refer to the:
- Federal regulations (42 CFR Section 405.1014), and
- Office of Medicare Hearings and Appeals (OMHA) website
Submit an ALJ Hearing Request
In Writing
In most instances, you will submit your written request to the Division of Centralized Docketing at the following address:
OMHA Central Operations
1001 Lakeside Avenue, Suite 930
Cleveland, OH 44114-1158
However, you should always defer to the address specified in the reconsideration determination you receive. Failure to do so will delay the processing of your request.
Revised 10/11/2023