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When Health Advantage denies a claim for benefits, the member receives a personal health statement (PHS) 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 a claim number), and date and provider of service.
Want to appeal a denied claim? Complete and submit this form with any additional information, and your request will be reviewed:
Member Appeal Submission Form
[pdf]
Designation of Authorized Appeal Representative [pdf]
You must file an appeal within 180 days after you have been notified of the denial of benefits.
Send requests for review of a denial of benefits in writing.
Write on the envelope:
Internal Review Request
Mail the request to:
Appeals Coordinator
Health Advantage
P.O. Box 8069
Little Rock, AR 72203-8069