Where do I submit Hearing and Appeals and Administrative Reviews?
Hearing and Appeals, as well as Administrative Reviews, will be completed by the PA vendor who denied the request. (In the event that the Hearing and Appeal or Administrative Review is submitted to the incorrect CMO or FFS organization, the request will be returned to the provider for submission to the appropriate organization for review.) If the member has been assigned to a different program since the request for PA was denied, providers can either appeal to the PA vendor that denied the request or submit a new PA request for review to the current CMO/FFS PA vendor for review. The policies and procedures regarding Hearing and Appeal or the Administrative Review process will remain the same as they are currently published. This information is distributed to the provider and member upon the generation of the PA decision letter or PA update. Further information regarding the Hearing and Appeal and the Administrative Review process can be found in Chapter 6 of the IHCP Provider Manual, C
Hearing and Appeals, as well as Administrative Reviews, are completed by the PA vendor that denied the request. (In the event that the Hearing and Appeal or Administrative Review is submitted to the incorrect CMO or FFS organization, the request is returned to the provider for submission to the appropriate organization for review.) If the member has been assigned to a different program since the request for PA was denied, providers can appeal to the PA vendor that denied the request or submit a new PA request for review to the current MCO/CMO/FFS PA vendor for review. The policies and procedures regarding Hearing and Appeal or the Administrative Review process are distributed to the provider and member upon the generation of the PA decision letter or PA update. Further information regarding the Hearing and Appeal and the Administrative Review process can be found in Chapter 6 of the IHCP Provider Manual.
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- Where do I submit Hearing and Appeals and Administrative Reviews?
