A Superior Member Advocate can help you with any questions you have about filing an emergency appeal. Texas Health & Human Services Commission. Albany, NY 12210. You, your provider or another person acting on your behalf can file an appeal. MAXIMUS will also send a written version of the decision within 48 hours of the phone call. AHCCCS Contacts A .gov website belongs to an official government organization in the United States. This tool provides registered ASETT usersan additional level of security for filing complaints through Multi-Factor Authentication (MFA) and Remote IdentityProofing and allows attaching supportingdocumentation. Sign up to receive our weekly newsletter and get all the latest news and updates, including the most recent episode of AFMC TV, right to your inbox! Call Superior Member Services for more information. To file your complaint, send to: Superior HealthPlan An Independent Review Organization is a third-party organization contracted by HHS that conducts an External Medical Review related to Adverse Benefit Determinations based on functional necessity or medical necessity. To qualify for an emergency External Medical Review and emergency State Fair Hearing review, you must first complete Superiors internal appeals process. Official websites use .govA WebMedicaid Program Important Phone Numbers Fraud. Unhappy with your health plan or Medicaid services? Web1800 132 468 if you need help with a complaint the National Relay Service if youre deaf, have hearing loss or have speech disability our free direct-call TTY service on 1800 810 586 one of our international phone numbers if youre overseas. Helpful Phone Numbers - Department of Human Services Go to Medicaid Information about the health care programs available through Medicaid and how to qualify. HHS will give you a final decision within 90 days from the date you asked for the State Fair Hearing. Austin, TX 78741 Superior will make a decision about your expedited appeal within one (1) Business Day, and send you a letter within 72 hours. Within five (5) Business Days, Superior will give the examiner all documents and information used to make the internal appeal decision. Call Medicaid Managed Care Helpline at 1-866-566-8989 (toll free). Instead, Kemp is limiting expanded coverage to adults earning up to 100% of the poverty line $14,580 for a single person or $30,000 for a family of four. lock External links are made available for the convenience of the internet user. complaints If you are not satisfied with the complaint resolution, within thirty (30) days, you can request an appeal of the complaint resolution. You can also submit your complaint online: For licensed health care facilities, please use the Licensed Facility Complaint form. A complaint is about the quality of care you got or are getting. The External Review process is managed by MAXIMUS Federal Services for CHIP members. You can call Member Services at 1-800-783-5386 with any questions. Medicaid members will have sixty (60) calendar days from the date of Superiors Notice of Adverse Benefit Determination letter to appeal the decision. Secure .gov websites use HTTPSA Your appeal will be processed as a standard appeal with a response provided within 30 days. You can also contact the HHS State Fair Hearing officer if you would like the hearing to be held in-person. You can call or request in writing to let us know you want to appeal an Adverse Benefit Determination. WebHOW TO SUBMIT A COMPLAINT. Web1-800-482-5431. Contact | Medicaid WebFile a Complaint. For example, a complaint from someone who cannot pick up his medication at the pharmacy is worked before a complaint about an unpaid medical bill. If you believe that waiting for a standard External Medical Review will seriously jeopardize your life or health, or your ability to attain, maintain, or regain maximum function, you, your parent or your legally authorized representative may ask for an emergency External Medical Review and emergency State Fair Hearing by writing or calling Superior HealthPlan. They may call you to get more information, if needed.Researched We research your complaint. Medicaid Health Plan Complaints: You may file a Health Plan complaint when you have the following problems: As alleged in the criminal complaint, from May 2017 through June 2021, the defendant, through his company, billed Medicare and Medicaid for over $3.9 million in occupational therapy Most hearings are held by telephone. Toni King is an author and columnist on Medicare and health insurance issues. Unregistered users can still file a complaint by clicking on the Get Started button on the ASETT home page. If you suspect a child has been abused or mistreated, you are required to report it to the Texas Department of Family and Protective Services or to a law enforcement agency. You have the right to appeal Superiors decision if CHIP covered services are denied based on lack of medical need. Written complaints can be sent on paper or electronically. New Please do not send Provides a partial approval of a request for a covered service. Secure .gov websites use HTTPSA If you are unhappy with Superior, you may file a complaint (PDF). At Modivcare, we expect each trip to be completed safely and on time. You must fill out the HHS Federal External Review Request Form (PDF)that is sent with the adverse benefit determination or appeal letter. Complaints To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: https://www.usda.gov/sites/default/files/documents/ad-3027.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. Lock During the hearing, you or your representative can tell why you need the service or why you disagree with the Superiors action. Phone: 1-800-206-8125. Texas Health and Human Services (HHS) state office headquarters is located at:North Austin Complex4601 W. Guadalupe St.Austin, TX 78751-3146P.O. Superiors denial is called an adverse benefit determination. You can appeal the adverse benefit determination if you think Superior: You, a doctor or someone else acting on your/your childs behalf can appeal an adverse benefit determination. Medicaid Complaint Hotline | Help with Medicaid Service | AFMC Abuse of Medicare and Medicaid harms not only the programs but also the everyday people whose tax money is used to fund these healthcare programs. Box 149347Austin, Texas 78714-9347. Toni King is an author and columnist on Medicare and health insurance issues. How you file a complaint depends on what your While the headquarters offices are located in Austin, there are offices across the state that serve Texans. Anyone can submit a complaint to the Agency using the Florida Medicaid Complaint Form. When you file a complaint, you get a tracking number. Eastern District of New York - United States Department of Justice WebMedicaid Director Office of Health Insurance Programs The Medicaid Update is a monthly publication of the New York State Department of Health Office of the Medicaid Inspector General: For suspected fraud, waste or abuse complaints/allegations, call 1-877-87FRAUD, (877) 873-7283, or visit Office of Medicaid Inspector General (OMIG) web site. Download the Arkansas Medicaid Handbook (PDF) for more information. Webcomplaint. You can also complain to the Texas Health and Human Services Commission (HHSC) by emailing. To check on the status of your benefits or application, call 2-1-1 or log-in to yourtexasbenefits.com. OCR manages HIPAA privacy and security complaints and enforcement activities. We accept complaints about fraud, waste and abuse in Medicare, Medicaid and other HHS WebBilling concerns or plan's refusal to pay for a covered service. If you believe that waiting for a State Fair Hearing will seriously jeopardize your life or health, or your ability to attain, maintain, or regain maximum function, you or your representative may ask for an emergency State Fair Hearing by writing or calling Superior at 1-877-398-9461. You will be notified of the appeal decision within one (1) business day for denials of on-going emergency or denial of continued hospital stay. Sunflower Health Plan Customer Service (877-644-4623) (TTY: 711) Kansas Medicaid, known as KanCare, can be hard to understand. To ask for a State Fair Hearing, you or your representative should write or call Superior: To ask for an External Medical Review, you or your representative may either: If you ask for an External Medical Review within 10 days from the time you get the appeal decision from Superior, you have the right to keep getting any service Superior denied, based on previously authorized services, at least until the final State Fair Hearing decision is made. You or someone acting for you will receive written notice of the final External Review decision as soon as possible. Office of the OmbudsmanP. Medicaid Complaint Complaints The KanCare Ombudsman office can help with: Answers to questions; Resolving issues; Complaints Department Contact Us | Texas Health and Human Services Phone Number. You may name someone to represent you by writing a letter to Superior telling them the name of the person that you want to represent you. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. MyMedicare - Access to Your Personal Medicare Information, National Provider Identifier Standard (NPI), Clinical Laboratory Improvement Amendments (CLIA), Medicare Service Center: 800-MEDICARE (800-633-4227), Medicare Service Center TTY: 877-486-2048, Report Medicare Fraud & Abuse: 800-HHS-TIPS (1-800-447-8477), Toll-Free: 877-267-2323 (Employee directory available). Contact Us - Kansas You can call our toll-free hotline at888-987-1200,Monday through Friday, 8 a.m. to 4:30 p.m. Were here every day of the week, except state holidays. If you have question about the Beneficiary Complaint form or this process, call the 1-800-642-3195. Official websites use .govA FAX:1-866-918-2266. If you need help understanding the language being spoken, Superior has people who can help you on the phone or can go with you to a medical appointment. website belongs to an official government organization in the United States. Toni King is an author and columnist on Medicare and health insurance issues. You, your provider or another person acting on your behalf can file an appeal. Fill out the State Fair Hearing and External Medical Review Request Form provided as an attachment to the Member Notice of Superiors Internal Appeal Decision letter and mail or fax it to Superior by using the address or fax number at the top of the form; or. To file an Administrative Simplification HIPAA-related paper complaint rather than an electronic one, please complete this OMB-approved form 0938-0948 and An External Review is an outside review of your health plans denial of a service you and your doctor feel is medically necessary. You can file an appeal if you disagree with a coverage or payment decision made by one of these: Find Medicare.gov on facebook (link opens in a new tab), Follow Medicare.gov on Twitter (link opens in a new tab), Find Medicare.gov on YouTube (link opens in a new tab), A federal government website managed and paid for by the U.S. Centers for Medicare and Medicaid Services. A Superior Member Advocate can help you with any questions you have about filing an appeal. If You'd Like Assistance Reporting Suspected Fraud, the Senior Medicare Patrol (SMP) is Here to Help. A federal government managed website by theCenters for Medicare & Medicaid Services.7500 Security Boulevard Baltimore, MD 21244, An official website of the United States government, Improving Care for Medicaid Beneficiaries with Complex Care Needs and High Costs, Promoting Community Integration Through Long-Term Services and Supports, Eligibility & Administration SPA Implementation Guides, Medicaid Data Collection Tool (MDCT) Portal, Using Section 1115 Demonstrations for Disaster Response, Home & Community-Based Services in Public Health Emergencies, Unwinding and Returning to Regular Operations after COVID-19, Medicaid and CHIP Eligibility & Enrollment Webinars, Affordable Care Act Program Integrity Provisions, Medicaid and CHIP Quality Resource Library, Lawfully Residing Immigrant Children & Pregnant Individuals, Home & Community Based Services Authorities, March 2023 Medicaid & CHIP Enrollment Data Highlights, Medicaid Enrollment Data Collected Through MBES, Performance Indicator Technical Assistance, 1115 Demonstration Monitoring & Evaluation, 1115 Substance Use Disorder Demonstrations, Coronavirus Disease 2019 (COVID-19): Section 1115 Demonstrations, Seniors & Medicare and Medicaid Enrollees, Medicaid Third Party Liability & Coordination of Benefits, Medicaid Eligibility Quality Control Program, State Budget & Expenditure Reporting for Medicaid and CHIP, CMS-64 FFCRA Increased FMAP Expenditure Data, Actuarial Report on the Financial Outlook for Medicaid, Section 223 Demonstration Program to Improve Community Mental Health Services, Medicaid Information Technology Architecture, Medicaid Enterprise Certification Toolkit, Medicaid Eligibility & Enrollment Toolkit, SUPPORT Act Innovative State Initiatives and Strategies, SUPPORT Act Provider Capacity Demonstration, State Planning Grants for Qualifying Community-Based Mobile Crisis Intervention Services, Early and Periodic Screening, Diagnostic, and Treatment, Vision and Hearing Screening Services for Children and Adolescents, Alternatives to Psychiatric Residential Treatment Facilities Demonstration, Testing Experience & Functional Tools demonstration, Medicaid MAGI & CHIP Application Processing Time. Medicare WebIf you need help submitting a complaint, you can call our Medicaid Helpline at 1-877-254-1055 (TDD 1-866-467-4970). Copyright 2016-2023. Information in this page cannot respond to individual Medicare concerns. Important Telephone Numbers An internal health plan emergency appeal is when the health plan has to make a decision quickly based on the condition of your health, and taking the time for a standard appeal could jeopardize your life or health. One Commerce Plaza, Room 1609. Armstrong, Bailey, Briscoe, Carson, Castro, Childress, Cochran, Collingsworth, Crosby, Dallam, Deaf Smith, Dickens, Donley, Floyd, Garza, Gray, Hale, Hall, Hansford, Hartley, Hemphill, Hockley, Hutchinson, King, Lamb, Lipscomb, Lubbock, Lynn, Moore, Motley, Ochiltree, Oldham, Parmer, Potter, Randall, Roberts, Sherman, Swisher, Terry, Wheeler, Yoakum, Archer, Baylor, Brown, Callahan, Clay, Coleman, Comanche, Cottle, Eastland, Fisher, Foard, Hardeman, Haskell, Jack, Jones, Kent, Knox, Mitchell, Montague, Nolan, Runnels, Scurry, Shackelford, Stonewall, Stephens, Taylor, Throckmorton, Wichita, Wilbarger, Young, Collin, Cooke, Dallas, Denton, Ellis, Erath, Fannin, Grayson, Hood, Hunt, Johnson, Kaufman, Navarro, Palo Pinto, Parker, Rockwall, Somervell, Tarrant, Wise, Anderson, Bowie, Camp, Cass, Cherokee, Delta, Franklin, Gregg, Harrison, Henderson, Hopkins, Lamar, Marion, Morris, Panola, Rains, Red River, Rusk, Smith, Titus, Upshur, Van Zandt, Wood, Angelina, Hardin, Houston, Jasper, Jefferson, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Shelby, Trinity, Tyler, Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Harris, Liberty, Matagorda, Montgomery, Walker, Waller, Wharton, Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Coryell, Falls, Fayette, Freestone, Grimes, Hamilton, Hays, Hill, Lampasas, Lee, Leon, Limestone, Llano, Madison, McLennan, Milam, Mills, Robertson, San Saba, Travis, Washington, Williamson, Atascosa, Bandera, Bexar, Calhoun, Comal, DeWitt, Dimmit, Edwards, Frio, Gillespie, Goliad, Gonzales, Guadalupe, Jackson, Karnes, Kendall, Kerr, Kinney, La Salle, Lavaca, Maverick, Medina, Real, Uvalde, Val Verde, Victoria, Wilson, Zavala, Andrews, Borden, Coke, Concho, Crane, Crockett, Dawson, Ector, Gaines, Glasscock, Howard, Irion, Kimble, Loving, Martin, Mason, McCulloch, Menard, Midland, Pecos, Reagan, Reeves, Schleicher, Sterling, Sutton, Terrell, Tom Green, Upton, Ward, Winkler, Brewster, Culberson, El Paso, Hudspeth, Jeff Davis, Presidio, Aransas, Bee, Brooks, Cameron, Duval, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, Live Oak, McMullen, Nueces, Refugio, San Patricio, Starr, Webb, Willacy, Zapata. Superior will acknowledge your appeal within five (5) Business Days of receipt, and complete the appeal within 30 calendar days. Sign up to get the latest information about your choice of CMS topics. Call Member Services at the number on the back of your ID card. The criminal complaint charges a total of 9 counts, all 4-year felonies. You can call Member Services at 1-800- 783-5386 (TTY: 1-800-735-2989) with any questions. should be communicated through the existing Centers for Medicare & Medicaid Services' resources, identified below. The MDCP/DBMD Escalation Help Line assists people with Medicaid who get benefits through the Medically Dependent Children Program (MDCP) or the Deaf Blind with Multiple Disabilities (DBMD) program. An expedited appeal is when Superior HealthPlan has to make a decision quickly based on the condition of your health, and taking the time for a standard appeal could jeopardize your life or health. The State Fair Hearing officer will provide a response on your expedited State Fair Hearing request within three (3) business days. Is denying coverage for care you think should be covered. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Find out what happens when NSG receives a complaint, To file your HIPAA transactions, code sets, unique identifiers (employer and provider Identifiers) or operating rules complaint electronically, go to the, Administrative Simplification Enforcement Testing Tool (ASETT), To file an Administrative Simplification HIPAA-related paper complaint rather than an electronic one,please complete this OMB-approved form 0938-0948 and return it to the Centers for Medicare & Medicaid Services (CMS) with any related supporting documentation, To file a HIPAA Privacy Rule and Security Rule complaint, please contact the HHS, Administrative Simplification Enforcement and Testing Tool, How to File a Complaint Infographic (PDF), HIPAA Administrative Simplification (Non-privacy/Security) Complaint Form (PDF).