The goal of the grievance and appeal process is to resolved disputes fairly and enhance member and public confidence. It allows for the independent review of Medicaid program decision concerning appealable actions.
A coordinator is responsible for ensuring the timely processing and resolution of grievances and appeals.
Click below to access the grievance and appeal database:
Global Commitment to Health Appeals and Grievances Database
Resources
-
Grievance and Appeals Manual
- Procedures for Grievances, Appeals and Fair Hearings of Medical Services
Letter Templates:
- Appeal Acknowledgement Letter
- Appeal Approved Letter
- Appeal Beneficiary Extension Letter
- Appeal Consent for a Provider
- Appeal Meeting Invitation Letter
- Appeal Expedited Approved Letter
- Appeal Expedited Denied Letter
- Appeal Expedited Does Not Meet Criteria Letter
- Appeal Decision Denied Letter
- Appeal Filed Late Letter
- Appeal/Grievance Forwarded to Correct Department
- Appeal Withdrawn
- Right to Appeal From Internal
- Grievance Acknowledgement Letter
- Grievance Response Letter
- Grievance Orally Withdrawn Letter