HOW TO: Create and Complete an Appeal

If a participant chooses to appeal a decision made on a SDR, end users can initiate the appeal process directly within CareHub. To begin, move the SDR into the “In Appeal” status and create the associated appeal record by entering the following information:

• Appeal timeframe
• Appeal type
• Appeal source
• Date of appeal request
• Method of receiving appeal
• Appeal documentation
• Name(s) and Credentials of 3rd party reviewers.
• Acknowledgement that all parties were able to submit evidence.
• Acknowledgement that all other services are continuing to be provided.
• If the participant has Medicaid, acknowledgement that services are continuing to be provided during the appeal process.

Users will need to approve or deny the appeal once the appeal process has been completed. If denied, please pick specific reason for denial.

 

Important Notes

✔ Add as much detail as possible to the appeal including comments with updates on the process to ensure tracking within CareHub.

✔ Attach all information and letters between the PO and 3rd party reviewers for easy tracking of information.