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Appeals Policies and Processes

This page explains the rights that recipients have to appeal an Alliance decision, and how that process works.

Sometimes Alliance Health may deny, suspend, reduce or terminate a request your provider makes for you for state-funded services offered by our plan. If that happens, you will receive a letter from Alliance Health notifying you of any decision to deny, suspend, reduce or terminate a service request your provider makes. All policies and procedures related to appeals for UM decisions are in adherence with 10A NCAC 27G .7004. The letter will include information regarding the reason for the decision and any available options while the appeal is under review. State-funded services recipients have the right to appeal decisions to deny, suspend, reduce or terminate their services. Alliance Health must receive the appeal in writing within 15 working days from the date of the letter.

When you ask for an appeal with the Health Plan, Alliance Health has 7 business days to give you an answer. You can ask a family member, a friend, your provider or a legal representative to help you with your appeal. You or your legal guardian can ask for an appeal. You can call Alliance Health at 919-651-8545 or email [email protected] if you need help with your appeal request. It’s easy to ask for an appeal by using one of the options below:

  • MAIL: Fill out and sign the appeal request in the notice you receive about our decision. Mail it to the address listed on the form. We must receive your form no later than 15 working days after the date on the notification letter.
  • FAX: Fill out, sign, and fax the Appeal Request Form in the notice you receive about our decision. You will find the fax number listed on the form. We must receive your form no later than 15 working days after the date on the notification letter.
  • EMAIL: Fill out, sign, and email the Appeal Request Form in the notice you receive about our decision. You will find the email listed on the form. We must receive your form no later than 15 business days after the date on the notice. To appeal the reduction, suspension, termination or denial of non-Medicaid benefits, you must complete and return the Non-Medicaid Services Appeal Form (included in the notice of decision mailed to you) to any of the following within 15 working days of the date of the notification letter.
  • WEBSITE: Appeals can also be submitted through the web portal.

Timelines for Appeals

We will make a decision on your appeal within 7 business days from the day that we get your appeal request. We will mail you a letter to tell you about our decision.

Decisions on Appeals

When we decide on your appeal, we will send you a letter. If you do not agree with our decision, you can ask for an appeal with the State Mental Health/Developmental Disability/Substance Abuse (MH/DD/SA) Appeals Panel. The request for a state-level appeal must be received within 15 calendar days from the date of the letter from Alliance Health. When recipients do not agree with our decisions on an appeal, the recipient or legal guardian can ask the State Appeals Panel for an appeal.

State Non-Medicaid Appeals Panel

The State Non-Medicaid Appeals Panel will review your request and will issue their findings and decisions. The Director from Alliance Health will issue a final written decision on your request based on the State Non-Medicaid Appeals Panel’s findings. We make a final decision within 10 days of receiving the Panel’s findings.

You must go through our appeal process before you can appeal to the state.

If you would like to request a hearing by the State Non-Medicaid Appeals Panel, you must complete the Non-Medicaid Hearing Request form attached to your decision letter and mail or fax it to:

DMH/DD/SAS Hearing Office
c/o Customer Service and Community Rights
Mail Service Center 3001, Raleigh, NC 27699-3009
Phone: 984-236-5300
Fax: 919-733-4962

Continuation of Services During an Appeal

Sometimes Alliance Health’s decision reduces or stops a health care service you are already getting. You can ask to continue this service without changes until your appeal is finished. Alliance Health is not required to continue this service. To request for services to continue during your appeals, contact Alliance’s Appeal Department at 919-651-8641 or email [email protected].

This page was last reviewed for accuracy on 02/06/2022