How do I file an appeal?

Our claims department also handles all appeals. You always have the right to appeal a determination within 45 calendar days of either a payment receipt or a denial notification.

All appeals of claim denials that result from authorization or medical management issues should refer to section 7.15 of the Provider Manual.

For all other claims, be sure to include:

An explanation for the appeal
All other pertinent information and supporting documentation
A copy of the original claim
A copy of the original EOP
For Medicare appeals only, an AOR form (INN) or a WOL statement (OON)

For Medicaid, Medicaid Advantage Plus (MAP), SNP, HARP, MLTC, CHPlus, Essential, MetroPlus Gold, and Gold I and II plans, send an appeal by regular mail to:

MetroPlusHealth
P.O. Box 219080
Kansas City, MO 64121-9080

For Medicare Advantage Plans and MarketPlace QHP, send an appeal by regular mail to:

MetroPlusHealth
P.O. Box 219374
Kansas City, MO 64121-9374

Send any appeal by certified mail to:

MetroPlusHealth
Attn: Claims
50 Water Street, 7th Floor
New York, NY 10004

Send any appeal by fax to 212-908-8789.