Client Appeal Request Form 2021-05-21-2025

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Medicaid/FAMIS Renewals By contacting their Medicaid/FAMIS health plan, Managed Care Organization (MCO) Online at Commonhelp.virginia.gov, By calling Virginias One Benefits line at 1-833-5CALLVA, or. By contacting their local DSS.
You can find a DMAS appeal form at . You can also write your own letter. Include a full copy of your notice of action and any documents you want DMAS to review during your appeal. If you have questions about an appeal, call the DMAS Appeals Division at 804-371-8488.
You can fax the appeal to the Bureau of Hearings at 312-793-3387, You can submit the form online through the ABE system, or. You may call 1-800-435-0774 (TTY: 1-877-734-7429). The call is free.
3) Appealing the Medicaid Denial Typically, an applicant has between 30 and 90 days to appeal, or in other words, request a Medicaid Fair Hearing. Once requested, a date for the hearing is set. A states Medicaid agency must have the hearing and issue a decision within 90 days of receiving the hearing request.
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