The state Non-Medicaid Appeal Panel will review your request and will issue a decision on your service request. Alliance Health will make a final decision on your request that is informed by the state Non-Medicaid Appeal Panel decision. We will make a final decision within 10 days of the panel’s decision. All policies and procedures related to appeals for UM decisions are in adherence with 10A NCAC 27G .7004.
To file an appeal with the state Non-Medicaid Appeal Panel, you must mail or fax a completed Non-Medicaid Appeal Request Form to:
- Mail:
DMH/DD/SAS Hearing Office c/o Customer Service and Community Rights
Mail Service Center 3001
Raleigh, NC 27699-3001 - Fax: 919-733-4962
The Non-Medicaid Appeal Request Form is included in the decision letter. Remember that DMH/DD/SAS must receive the request form no later than 11 calendar days from the date of the Alliance appeal decision letter. Appeals are heard by a DMH/DD/SAS hearing officer at an Alliance Health office location. If you have questions about the state appeal process, please call DMH/DD/SAS at 984-236-5300.
When they receive an appeal request, DMH/DD/SAS will:
- Review the appeal to determine your eligibility to appeal.
- Accept or deny the appeal. If the appeal is accepted, the office will contact you to schedule a non-Medicaid appeal hearing (with at least 15 days’ notice).
- Request documentation from Alliance used in the initial decision and appeal.
The non-Medicaid appeal hearing:
- Is conducted by a DMH/DD/SAS hearing officer pursuant to a waiver issued by the Commission for MH/DD/SAS; absent this waiver, the Non-Medicaid Appeal is conducted by a Non-Medicaid Appeals Panel
- Is conducted in person
- Is scheduled for 2 hours
- Is attended by the appellant (person who filed the appeal) and/or their representatives
- Is attended by one or more Alliance Health representatives
Within 60 days of the written request for appeal, the DMH/DD/SAS hearing officer will issue a written decision that includes findings, decisions and recommendations to you or your legal representative and the Alliance chief executive officer. Within 10 calendar days of receipt of the hearing officer’s findings, Alliance Health will issue and send a written final decision to you or your legal representative.
Alliance Health ensures members are not discouraged, coerced (forced) or misinformed (given wrong information) regarding the type, amount and duration (length) of services they may request. In addition, Alliance Health does not discourage, coerce (force) or misinform (give wrong information) members about the right to appeal the denial, reduction or termination (stopping) of a service.
