Medicaid Level II appeals process

If we deny your first appeal, you may follow this process to file a Level II appeal.

Deadline

Within one year of the date of service

Make your request

Complete a Level II appeal form and submit it using your secure Mailbox. Be sure to include new documentation showing why we should reconsider our initial denial of your request.

Level II appeal process

  1. Priority Health staff and/or third-party consultants will make a decision on your Level II appeal within 30 days of receipt.
  2. We will inform you of the outcome of the review either by remittance advice or by adverse determination letter within 5 business days of the decision.

What items are necessary for a medical appeal?

  • Level 2 appeal form 
  • Appeal level letter (outlining what you are appealing and why we should reconsider our decision) 
  • New pertinent supporting documentation