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How To File an Appeal
When Health Advantage denies a claim for benefits, the member receives an explanation
of benefits (EOB) explaining the reason for the denial. The member has the right
to file an appeal to request review of the denial of a claim in whole or in part.
An appeal must be submitted in writing. The appeal should include member name, health
plan ID number, a reference to the claim being appealed (such as claim number),
and date and provider of service.
When To Submit an Appeal
You must file an appeal within 180 days after you have been notified of the denial
of benefits.
Where To Submit an Appeal
Send requests for review of a denial of benefits in writing. Write on the envelope:
Appeal Request
Send the request to:
Member Response Coordinator
Health Advantage
P.O. Box 8069
Little Rock, AR 72203-8069
Two Levels of Review
If the outcome of the first-level review is adverse, all Health Advantage members
except Arkansas state and public school employees may appeal to the second level.
The request for a second-level appeal must be made within 60 days after the member
has been notified of the result of the first-level review. The member may appear
in person or via teleconference during the second appeal. State and public school
employees have a different appeals process, which is outlined on their state benefits
site
.
For Assistance
If you need assistance in filing an appeal, you may call 1-800-843-1329.
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