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What is the process if a member has a complaint or wants to appeal an MCO’s decision?

April 26, 2017appeal complaint decision mco process wants

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What is the process if a member has a complaint or wants to appeal an MCO’s decision?

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MCO and DHMH have dispute resolution processes in place for PAC. They are the same systems that are in use for handling complaints and appeals under HealthChoice except that PAC members do not have appeal rights for non-covered services. DHMH will monitor access and quality.