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 may 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). 

Level II Hearing Procedures

MA organizations must follow the MA RADV Level II Appeal Procedures below.

Electronic Filing Required

The CMS Hearing Officer requires MA RADV appeals to be filed electronically through the Office of Hearings Case and Document Management System (“OH CDMS”). For OH CDMS registration instructions, please reference the External Registration and User Access Manual. 

Once an MA organization is registered in OH CDMS, please see the MA RADV Module External User Manual for technical instructions regarding how to file and maintain your MA RADV appeal. Depending on the type of appeal the organization is filing, a plan may refer to one of the applicable Quick Start Guides: 

1. Medical Record Appeal of a Medical Record Review Reconsideration Determination Appeal, 
2. Payment Error Calculation (PEC) Appeal, and 
3. PEC Appeal Following Issuance of a Revised Audit Report or Reissued Original Audit Report.

For any system or registration questions, contact the OH CDMS Help Desk at 1-833-783-8255 or Helpdesk_OHCDMS@cms.hhs.gov.

Correspondence

For general non-system questions, please direct your inquires to the Office of Hearings via e-mail at MARADVHearings@cms.hhs.gov.