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Claim Reconsideration Request Form Date: / / Please submit the request by visiting our Provider Portal, or fax to (800) 4993406. Attach all required supporting documentation. Incomplete forms.
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Reconsideration FAQ
Corrected claims, adjustments, or reconsiderations should be submitted within 180 days of the original claim paid date in order to be considered for reprocessing.
You have 60 days from the date on the Notice of Action to file an appeal with Molina Healthcare. You may file an appeal by calling Member Services or by writing us and sending it by mail or by fax.
An appeal can be started through a verbal or written request. Medicaid enrollees and MI Health Link enrollees have sixty (60) calendar days to request a local appeal from the date of the Notice of Adverse Benefit Determination.
Molina Healthcare of Michigan, 100 W. Big Beaver Road, Suite 600 Attn: Claims, Troy, MI 48084-5209 Or Fax to: (248) 925-1768. Please contact our Provider Services Call Center at 1-888-898-7969.
If you have already received the care that is being denied, you should have the denial on your EOB. An appeal of this decision is called a post-service appeal. If the denial is for a service or item that you have not yet received, you should get a Notice of Denial of Medical Coverage from your plan.
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