Medicare Beneficiary and Medicare Advantage Part C Plan Enrollee or Part D Plan Enrollee Appeals and Assistance

If you are a Medicare Beneficiary, Medicare Advantage Part C Plan Enrollee or Part D Plan Enrollee, or a representative of a Beneficiary or Enrollee (“Medicare Beneficiary and Enrollee”), and have questions about or need assistance with a request for an Administrative Law Judge (ALJ) hearing filed with OMHA, please call the Toll Free OMHA Beneficiary Help Line at (844) 419-3358.

To help ensure Medicare Beneficiary and Enrollee appeals are adjudicated as quickly as possible, OMHA designates appeals filed by Beneficiaries and Enrollees as priority appeals, with some exceptions. We generally do not prioritize appeals if another party to the appeal (such as a provider, supplier, or Medicaid State Agency) represents the Beneficiary or Enrollee, or if another party to the appeal and the Beneficiary or Enrollee share a representative (such as an attorney who represents both parties to the appeal), unless:

• The Beneficiary or Enrollee was discharged from a facility or has not received the item or service in question;
• The Beneficiary or Enrollee is financially responsible for the item or service in question, beyond standard deductibles and co-payments or co-insurance;
• The Beneficiary or Enrollee is financially responsible for related items or services (such as additional dates of service for the same item or services) that have been denied and are being appealed; or
• The denied item or service is preventing the Beneficiary or Enrollee from receiving additional related items or services (such as the same items or services, or items or services that require Medicare coverage of the denied item or service for the related item or service to be covered).

Medicare Beneficiaries and Part D Plan Enrollees should send their appeals to the following address and mail stop to help ensure they are processed as quickly as possible:

OMHA Central Operations
Attn: Beneficiary Mail Stop
1001 Lakeside Ave., Suite 930
Cleveland, OH 44114-1158

Part C Plan Enrollees should send their appeals to the address specified in the instructions that came with the Part C reconsideration.

Our goal is to adjudicate appeals filed by Medicare Beneficiaries and Enrollees within 90 days, and certain Part D appeals may be expedited and adjudicated within 10 days—see the appeal instructions that came with the Part D reconsideration for instructions on requesting an expedited Part D ALJ hearing. If a Beneficiary or Enrollee appeal does not appear to be receiving this priority processing, please contact the OMHA Beneficiary Help Line at (844) 419-3358.

Other callers please use the OMHA National Toll Free Line for assistance at (855) 556-8475.