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Provider Manual

Provider Responsibilities Regarding Medicare Advantage Member Appeal

Last Updated on January 24, 2019

Providers should provide Medicare Advantage members with their appeal rights whenever benefits are denied for care the member believes should be covered by Security Health Plan. Members should be referred to Security Health Plan Customer Service to discuss appeal options. If a provider wants to file an appeal on behalf of a member, the member must sign the “Appointment of Representative” form.

Medicare Advantage Member Appeals and Grievance Policies

Information regarding appeals and grievances appears in the Evidence of Coverage (EOC) that Medicare Advantage members receive upon enrollment.