Discontinued appeal forms no longer accepted July 1

(June 26, 2017) - Starting July 1, you are required to use the current Level 1 and Level II appeal forms. We will discontinue faxing back educational reminders if you are using an old form. If your appeal is not on the correct form or the requirements are not met your appeal will not be processed.

Current forms are dated at the bottom: Level I (05/2017), Level II (04/2017).


Check out additional information and resources in the Review and Appeals section.