Medicare Advantage Risk Adjustment Data Validation Appeals

The CMS Hearing Officer is the second level of review in the MA RADV appeals process.  42 C.F.R. § 422.311.  Audited plans that disagree with their Reconsideration Decision regarding their medical record review determination or payment error calculation should file their request for hearing before a Hearing Officer in accordance with the information provided below.  See 42 C.F.R. § 422.311(c)(6)(iv), (c)(7).

Electronic Filing Required

The Hearing Officer requires MA RADV appeals to be filed electronically through the Office of Hearings Case and Document Management System (“OH CDMS”). Reference Hearing Officer Electronic Filing for registration instructions and the system user manual.  For any system or access questions, please contact the OH CDMS Help Desk at 1-833-783-8255 or Helpdesk_OHCDMS@cms.hhs.gov.