Quality Improvement Organization Manual (Pub. 100-10), Ch. 7 § 7540
Routing the Hearing Claim File to Office of Hearings & Appeals
7540 - Routing the Hearing Claim File to Office of Hearings & Appeals
(OHA) - (Rev. 4, 07-18-03)
Follow instructions found in Exhibit 7-61 on "How to Locate the Correct Hearing
Office." Prior to forwarding the claim file to the hearing office, attach the CMS-3509,
Health Insurance Appeal Case Form, to the front of the folder (See Exhibit 7-67). This
form provides the routing instructions for the hearing office after it completes its action
on the request. It is important to place this form on all folders sent to OHA and to check
the correct return address block.
NOTE: This form is printed on yellow heavy stock paper. Do not photocopy the form.