AHCCCS/ALTCS Service Appeal Process Flow Chart

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Presentation transcript:

AHCCCS/ALTCS Service Appeal Process Flow Chart Consumer Requests Service 14 DAYS R9-34-206 AHCCCS/ALTCS Health Plan Approves Service AHCCCS/ALTCS Health Plan denies service and sends Notice of Action Contents (R9-34-205) Action taken Reasons for action Appeal Rights Appeal Procedures Expedited Appeal Process Rights to continued service 60 DAYS R9-31-209 Consumer Must File Appeal within 60 days of receiving written notice 30-45 DAYS (with extension) R9-34-213 AHCCCS/ALTCS Health Plan again denies service and sends Notice of Appeal Resolution in writing AHCCCS/ALTCS Health Plan Approves Service Contents (R9-34-216) Results of health plan’s decision on Consumer’s appeal Right to request fair hearing and how to request Factual and legal basis for health plan’s decision 30 DAYS R9-34-217 Consumer has 30 days from date of notice to file for Fair Hearing 30 DAYS Fair Hearing at Office of Administrative Hearings (OAH) 50 DAYS Administrative Law Judge Issues Recommended Decision to AHCCCS (w/in 20 days of hearing A.R.S. 41-1092.08(a)) & AHCCCS Director Reviews ALJ Decision & Issues Director’s Decision (30 days after ALJ decision R9-34-218

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