Response notice 2026

1. Click ‘Get Form’ to open the response notice in the editor.
2. Begin by entering the ALJ Appeal Number at the top of the form. This is essential for tracking your appeal.
3. Select your appellant type by checking one of the options: Beneficiary, Supplier, Provider, or Medicaid State Agency.
4. Fill in your Health Insurance Claim (HIC) Number and Beneficiary Name if applicable. If it’s the same as the party name, you can leave it blank.
5. Indicate the scheduled hearing details including date, time, and type of hearing (Video-Teleconference or In-Person).
6. Complete your contact information in the recipient section, ensuring all fields are filled accurately for effective communication.
7. Choose one of the options under Item 1 regarding your presence at the hearing and provide any necessary explanations.
8. If applicable, check any objections under Items 2 to 4 and provide detailed reasons as required.
9. Finally, sign and date the form before submitting it through our platform to ensure timely processing.

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