Related links
Sample Appeal Letter for Medical Assistance
I live in (name of county) in the State of Minnesota. Medical Assistance sent me a notice telling me authorization was denied. The date on the notice is (date).
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Section 7: Grievance and Appeals
Once notified in writing, the provider has thirty (30) working days to submit additional information or the claim dispute will be closed by Molina Healthcare.
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Medi-Cal Appeal Letter | Office of Developmental Primary Care
I am writing to request a Medi-Cal Fair Hearing for [Beneficiary]. [Beneficiary] is enrolled in [Medi-Cal Program or Managed Care Provider] in [County].
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