Filing an Appeal
If you receive a letter from Alliance that denies your request for Non-Medicaid services, you can appeal this decision. You may also appeal reductions, suspensions or a termination of existing services. Theses appeals are called complaints.
The first step in the appeals process is to request a Reconsideration Review of Alliance’s decision. This is submitted on the Alliance Non-Medicaid Service Appeal form.
Process for Requesting a Reconsideration Review
- You or your provider must complete and return the Service Appeal form to Alliance within 15 working days from the date of the notice of decision letter. You may return the form by fax, mail, email, verbally over the telephone or in person.
- You may ask to review any information utilized as part of the Reconsideration Review process.
- You may also submit any additional information you feel supports your request for Medicaid services.
- Alliance will notify you within 30 days of your complaint
If You Disagree with the Complaint Review Decision
If you disagree with the decision you may file an appeal with the Division of Mental Health. The form needed to start this appeal is enclosed with the complaint decision letter.
Medicaid Appeals Process
- If you disagree with a request decision regarding Medicaid services, you must file your appeal with the North Carolina Office of Administrative Hearings within 30 calendar days from the date listed on the decision notice. The appeal must be filed within 10 days to avoid a disruption of your services. You may represent yourself in this process or you may retain an attorney.
- After you file your appeal, you will be offered the opportunity to have your case mediated.
- If you accept mediation, it must be completed within 25 days of your request.
- If you decline mediation, or if mediation is unsuccessful, your appeal will proceed to a hearing.
- After the hearing, an administrative law judge will make a recommendation regarding your case.
- The North Carolina Department of Health and Human Services will review the administrative law judge’s recommendation and make the final decision.
- If you disagree with the final decision, you may retain an attorney and appeal your case to Superior Court.
To help you better understand the Medicaid appeals process, information regarding appealing a decision will be sent to you if a service that was requested on your behalf was denied or if your current service is reduced or terminated. To learn more about the appeals process, call the North Carolina Office of Administrative Hearings at (919) 431-3000 or call the Alliance 24 hour toll-free number at (800) 510-9132.