Appeals Unit

What We Do

The Health Care Appeals Team (HCAT) is responsible for both covered services and eligibility appeals and fair hearing processes.  It coordinates the internal covered services appeal process on standard and expedited timeframes.  It also processes and, where possible, resolves requests for fair hearings on eligibility determinations.

Who We Serve

The Health Care Appeals Team (HCAT) serves all Medicaid members as well as Qualified Health Plan (QHP) members.

How We Impact

The Health Care Appeals Team (HCAT) facilitates the process for members to address issues with their coverage or eligibility.  This not only benefits individual members, but it enables system-wide improvements by identifying patterns and working with other units to prevent issues from arising again.

Action Plan

SFY22 priorities are:

  • Ensuring the unit is able to handle the expected increase in the number of appeals filed once the current federal emergency has ended.
  • Continue to meet established SLA timelines.
  • Continue to resolve at least 50% of appeals prior to formal hearing.
  • Establishing a tracking mechanism to capture the PHE Unwind appeals data.
Measures
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Current Actual Value
Current Target Value
Current
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% Change
Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy