FYI --- ALJ Delay
Melissa A. Bolton, Admin. Dept.
Description
Collection
Title:
FYI --- ALJ Delay
Creator:
Melissa A. Bolton, Admin. Dept.
Date:
10/8/2013
Text:
I came across this on the Office of Medicare Hearing and Appeals website:
*** For Appeals Submitted After July 15, 2013 ***
Due to the overwhelming number of receipts and the existing workload within the
Agency, OMHA implemented a program that defers the assignment of most requests
for hearing received after July 15, 2013. Under this new docketing process, new
requests for hearing will be entered into our case processing system, then held
until they can be accommodated on an Administrative Law Judge's docket for
adjudication. Due to the volume of requests that we are receiving, there are
significant delays in assigning requests at this time. When your request is
assigned to an Administrative Law Judge, we will send you a Notice of
Assignment. Based on our current workload and volume of new requests, we
anticipate that assignment of your request for hearing to an Administrative Law
Judge may be delayed for up to 28 months.
Please note that we will continue to process Part D prescription drug denial
cases that qualify for expedited status within 10 days and will screen all
incoming requests to ensure Medicare beneficiary issues are prioritized given
that they often present emergent circumstances that must be promptly addressed.
I would suggest everyone look into having your claims escalated to the Medicare
Appeals Council (Level 4 of Appeal) after your claim has been at the ALJ for 90
days. We are just looking into exactly what we need to do in order to have the
claim escalated, but what I am seeing clearly states that you can have the claim
escalated after 90 days. We have been mailing our ALJ appeals with a tracking
number so we can prove the date it was received at the HHS OMHA Centralized
Docketing office.
Since I came across this by accident, I thought I would forward to everyone.
Melissa
Funding Assistant
*** For Appeals Submitted After July 15, 2013 ***
Due to the overwhelming number of receipts and the existing workload within the
Agency, OMHA implemented a program that defers the assignment of most requests
for hearing received after July 15, 2013. Under this new docketing process, new
requests for hearing will be entered into our case processing system, then held
until they can be accommodated on an Administrative Law Judge's docket for
adjudication. Due to the volume of requests that we are receiving, there are
significant delays in assigning requests at this time. When your request is
assigned to an Administrative Law Judge, we will send you a Notice of
Assignment. Based on our current workload and volume of new requests, we
anticipate that assignment of your request for hearing to an Administrative Law
Judge may be delayed for up to 28 months.
Please note that we will continue to process Part D prescription drug denial
cases that qualify for expedited status within 10 days and will screen all
incoming requests to ensure Medicare beneficiary issues are prioritized given
that they often present emergent circumstances that must be promptly addressed.
I would suggest everyone look into having your claims escalated to the Medicare
Appeals Council (Level 4 of Appeal) after your claim has been at the ALJ for 90
days. We are just looking into exactly what we need to do in order to have the
claim escalated, but what I am seeing clearly states that you can have the claim
escalated after 90 days. We have been mailing our ALJ appeals with a tracking
number so we can prove the date it was received at the HHS OMHA Centralized
Docketing office.
Since I came across this by accident, I thought I would forward to everyone.
Melissa
Funding Assistant
Citation
Melissa A. Bolton, Admin. Dept., “FYI --- ALJ Delay,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/235677.
