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Request for Reconsideration
This form must be filed and submitted to the Enrollment Services Office (Room 203). In addition, students are required to attach any document that will support.
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Claim Reconsideration Request Form (Non-Clinical
Please submit the request by: o Preferred method: via the Availity Essentials Portal o Fax to: ▫. Medicaid, Marketplace, and MyCare Ohio Medicaid Plan Post
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Form SSA-561 | Request for Reconsideration
If you do not wish to appeal a non-medical decision online, you can use the Form SSA-561, Request for Reconsideration. Some examples of non-medical
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