Sometimes Partners Health Management may deny or limit a request your provider makes for you for Medicaid benefits or services offered by NC Medicaid Direct. You have the right to appeal if you do not agree with a decision Partners made about your services.

You may ask for an appeal if your services are denied, reduced, stopped or limited. You can ask for an appeal yourself. You may also ask a friend, family member, provider, or lawyer to appeal for you.

If you are unhappy with the decision, you can ask for a State Fair Hearing from the North Carolina Office of Administrative Hearings.

You can read Partners’ Appeals Policy.

You may use the Medicaid Appeals Request Form to request a review in one of the following ways:

• MAIL: Fill out and sign the Appeal Request Form in the notice you get about our decision. Mail it to the address listed on the form. We must receive your form no later than 60 days after the date on the notice.

• FAX: Fill out, sign, and fax the Appeal Request Form in the notice you get about our decision. You will find the fax number listed on the form. We must receive your form no later than 60 days after the date on the notice.

• BY PHONE: Call 1-888-235-4673 and ask for an appeal. When you appeal, you and any person you have chosen to help you can see the health records and criteria Partners Tailored Plan used to make the decision. If you choose to have someone help you, you must give them permission.

Once you ask Partners for an appeal, you will get a decision in 30 days or less. Partners will send you a letter called a Notice of Decision.