Customer Service (CS) Enrollee Member Appeals

Customer Service (CS) Enrollee-Member Appeals Policy

Attachment: Adequate Notice of Adverse Benefit Determination Medicaid

Attachment: Adequate Notice of Adverse Benefit Determination Uninsured Underinsured

Attachment: Advance Notice of Adverse Benefit Determination Medicaid

Attachment: Advance Notice of Adverse Benefit Determination Uninsured Underinsured

Attachment: Appointment of Representative Form

Attachment: Enrollee Agreement for Request for Additional Information (Medicaid)

Attachment: Enrollee Agreement for Request for Additional Information (MHL)

Attachment: Enrollee Agreement for Request for Additional Information Form (Uninsured or UnderInsured)

Attachment: Grievance and Appeals Technical Assistance FY20

Attachment: Hearing Summary

Attachment: Local Appeal Procedures for Enrollees-Members (Medicaid)

Attachment: Local Appeal Request Form (Medicaid SMI IDD SUD)

Attachment: Local Appeal Request Form (MHL)

Attachment: Local Dispute Resolution for Enrollees/Members without Medicaid

Attachment: Maximus Case Submission Cover Sheet-Instruction Guide

Attachment: MI Health Link Member Procedures for Appeals

Attachment: MDHHS State Fair Hearings

Attachment: MOAHR Requisition Form

Attachment: Notice of Appeal Approval Form (Medicaid)

Attachment: Notice of Appeal Approval Form (MHL)

Attachment: Notice of Appeal Decision Form MHL

Attachment: Notice of Appeal Denial (Medicaid)

Attachment: Notice of Denial of Medical Coverage

Attachment: Notice of Dismissal of Medicare Appeal Request Form

Attachment: Notice of Local Dispute Resolution Approval (Uninsured-Underinsured)

Attachment: Notice of Local Dispute Resolution Denial (Uninsured or Underinsured)

Attachment: Notice of Our Failure to Make a Coverage Decision

Attachment: Notice of Receipt of Appeal Form (Medicaid SMI, IDD, SUD)

Attachment: Notice of Receipt of Appeal Form (MHL)

Attachment: Notice of Receipt of Local Dispute Resolution Review Form

Attachment: Notice of Receipt of Oral Appeal (MHL)

Attachment: Process Flowchart_Enrollee/Member Medicare Appeals

Attachment: Request for Additional Information (Medicaid SMI, IDD, SUD)

Attachment: Request for Additional Information (MHL)

Attachment: Request for Additional Information (Uninsured or UnderInsured)

Attachment: Request for Hearing Form