![]() It will explain the Level 2 External Appeal process for Medicaid services. This notice is called the Notice of Appeal Decision. If you ask for an appeal and we choose to deny your request for a Medicaid service or payment of a service, we’ll send you a written appeal denial notice. Member Appeal Form Part C (PDF) Coming Soon.Write, mail, FAX, deliver your appeal or call us.įor Standard or Expedited (Fast) Appeals: At no cost to you, you can also ask for a copy of the guidelines we used to make our decision. You can ask to see the medical records and other documents we used to make our decision before or during the appeal. Call your doctor if you need this information. Other information that shows why you need the item or service.Your appeal must be requested within 60 calendar days of the decision you are appealing and the request must include: It can be from you, your representative, or your doctor. To ask for an appeal you have to tell us. If we don’t give you a fast appeal, we’ll give you an answer within 15 days (or 7 days for drug appeals). If you want a fast appeal but your doctor did not ask, we may not approve it. If your doctor asks for a fast appeal, you will get one. You can ask for a fast appeal if you or your doctor think your health could be in danger. We can’t take extra time to make a decision if your appeal is for a Medicare Part B or Part D prescription drug. If we take extra days to make the decision, we will send a letter that explains why we need to take more time. ![]() However, if you or your provider asks for more time, or if we need to gather more information, we may take up to 14 more calendar days. We will tell you in 60 calendar days.įast Appeal - You will get an answer within 72 hours after we get your appeal. If your appeal is to pay you back, we will tell you in writing. ![]() If you had to pay for services and want to be paid back, you can ask us. We can’t take the extra days for a Part B or Part D prescription drug appeal. If we take the extra days to make a decision, we will send you a letter that explains why we need more time. However, if you or your provider ask for more time or if we need to gather more information, we may take up to 14 more calendar days. You will get a written answer on a standard appeal 15 calendar days after we hear your appeal (7 days for appeals related to medications). We will review our decision and let you know what we decide. The negative decision is called a coverage determination. If you do not like the choice we have made, you have the right to make an appeal. ![]() Standard Appeal – An appeal is the process to review a decision you may not like. Important Information About Your Appeal Rights There are 2 kinds of appeals: ![]()
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