Provider Appeals

Provider Appeals

• How do I submit a managed care provider appeal?

  A provider or provider’s authorized representative may submit a request for appeal in writing.

  To submit a managed care Appeal  by mail send to:

  Aetna 
  Appeal and Grievance Department 
  9401 Indian Creek Parkway
  Overland Park, KS 66210

  Sunflower 
  Quality Department
  8325 Lenexa Drive, Suite 200
  Lenexa, KS 66214
  
  United 
  Grievances and Appeals
  P.O. Box 31364
  Salt Lake City, UT 84131-0364

  To submit a managed care Appeal  in person go to:

  Aetna 
  Appeal and Grievance Department
  9401 Indian Creek Parkway
  Overland Park, KS 66210

  Sunflower 
  Quality Department 
  8325 Lenexa Drive, Suite 200 
  Lenexa, KS 66214
  
  United 
  Grievances and Appeals
  P.O. Box 31364
  Salt Lake City, UT 84131-0364

• Is there a Managed Care Appeal Form?

  • Aetna - No required form                                            
  • Sunflower  - https://www.sunflowerhealthplan.com/content/dam/centene/sunflower/pdfs/Provider-Appeal-Form.pdf
  • United - https://www.uhcprovider.com/en/health-plans-by-state/kansas-health-plans/ks-comm-plan-home/ks-cp-forms-refs.html

• Is there a deadline for filing a managed care provider appeal?

  Yes, the time frame within which a provider or provider’s authorized representative may submit an appeal with the contractor shall be 60 calendar days of the date of the notice of action, plus an additional three calendar days is allowed for mailing.

• What is the process once a managed care provider appeal has been submitted?

  If a provider requests an appeal the contractor is required to acknowledge the appeal within 10 calendar days of receipt.

  If a provider requests an appeal the contractor will review the appeal and issue a notice of appeal resolution. The contractor is required to review the appeal and issue the notice within 30 calendar days from the date of receipt.

• What documents do I need to submit for a managed care provider appeal?

  Providers should follow the submission requirements for each MCO for appeals. Providers are encouraged to include the claim number, reason for the request, and supporting documentation with their appeal request.