Part C Appeals

Part C Member Appeals

What is an Appeal?

If Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP) says no to your request for coverage you have the right to ask us to change our mind. To make an appeal means asking for another chance to get the coverage you want.

Making an Appeal

You must make your appeal within 60 days from the date on the letter we sent to you telling you our answer to your request for coverage. If you have a good reason for sending your appeal after the 60 days, we might give you more time.

Appeals Form…Coming Soon

How to File an Appeal:

You may file an appeal in one of three ways:  Call, Fax or Write:

Call Superior STAR+PLUS MMP at 1-866-896-1844 (TTY: 711). Hours are 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. 

Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP)
Attn: Appeals and Grievances – Medicare Operations
7700 Forsyth Blvd
Saint Louis MO 63105

If you ask in writing, your appeal must include your:

  • Name.
  • Address.
  • Member number.
  • Reasons for the appeal.
  • Medical records, notes or a letter from your doctor.

What Does Superior Do When You File an Appeal?

Superior STAR+PLUS MMP will have a different doctor look at your case to see if we should change our decision. We may need more information from you or your doctor. We must make sure we have everything done on time. We will get your appeal done as fast as your health needs, but no later than:

  • Medical Decisions (Part C & Medicaid) – Standard 30 days
  • Medical Decisions (Part C & Medicaid) – Fast 72 hours
  • Prescription Drug (Part D) – Standard 7 days
  • Prescription Drug (Part D) – Fast 72 hours

For more information, call Member Services at 1-866-896-1844. Hours are 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on holidays, you may be asked to leave a message. Your call will be returned the next business day. TTY users call 711. 

Part C Non-Contracted Provider Appeals

How Do Non-Contracted Providers File a Claim Appeal?  

The Centers for Medicare and Medicaid Services (CMS) says we must offer Medicare appeal rights to non-contracted providers for any claim which was denied payment.  Your Appeal Request should be sent to the following address:

Superior HealthPlan STAR+PLUS Medicare-Medicaid Plan (MMP)
Grievance and Appeals- Medicare Operations
P.O. Box 4000
Farmington, MO 63640-3822

Please be sure to include the following with your submission:

  • A completed and signed "Waiver of Liability" (WOL) form.
  • A copy of the Explanation of Payment (EOP) and relevant other doctor notes.

Our decision will be provided to you within 60 days from the date we received your appeal.

For more information, call Member Services at 1-866-896-1844. Hours are 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on holidays, you may be asked to leave a message. Your call will be returned the next business day. TTY users call 711. 

Part C Non-Contracted Provider Appeals

 

How Do Non-Contracted Providers File a Claim Appeal?  

The Centers for Medicare and Medicaid Services (CMS) says we must offer Medicare appeal rights to non-contracted providers for any claim which was denied payment.  Your Appeal Request should be sent to the following address:

Non-Contracted Provider Appeal Requests should be sent, with the filled out WOL and EOP, to:

[MMP_PRO_APPEAL_ADDRESS]

Please be sure to include the following with your submission:

  • A completed and signed "Waiver of Liability" (WOL) form.
  • A copy of the Explanation of Payment (EOP) and relevant other doctor notes.

Our decision will be provided to you within 60 days from the date we received your appeal.

For more information, call Member Services at [PHONE]. Hours are from 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on holidays, you may be asked to leave a message. Your call will be returned the next business day. TTY users call 711. 

 

Part C Non-Contracted Provider Appeals

 

How Do Non-Contracted Providers File a Claim Appeal?  

The Centers for Medicare and Medicaid Services (CMS) says we must offer Medicare appeal rights to non-contracted providers for any claim which was denied payment.  Your Appeal Request should be sent to the following address:

Non-Contracted Provider Appeal Requests should be sent, with the filled out WOL and EOP, to:

[MMP_PRO_APPEAL_ADDRESS]

Please be sure to include the following with your submission:

  • A completed and signed "Waiver of Liability" (WOL) form.
  • A copy of the Explanation of Payment (EOP) and relevant other doctor notes.

Our decision will be provided to you within 60 days from the date we received your appeal.

For more information, call Member Services at [PHONE]. Hours are from 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on holidays, you may be asked to leave a message. Your call will be returned the next business day. TTY users call 711. 

 

Last Updated: 09/30/2017
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