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Providers Filing Appeals on Enrollees' Behalf

On May 6, 2016, The Centers for Medicare & Medicaid Services (CMS) issued the Medicaid Final Rule to modernize Medicaid managed care and ensure appropriate beneficiary protections. One aspect of this Rule is that it reemphasizes that providers are required to obtain an enrollee’s written consent before acting on the enrollee’s behalf in requesting an appeal such as a pre-service appeal.

In accordance with the Final Rule, effective with appeals requests submitted 3/1/2017 and after, providers filing appeals on an enrollee’s behalf will be required to submit proof of written consent before the plan can address and resolve the appeal.

Providers may continue to request appeals regarding the denial of claim payment on their own behalf.

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Última actualización:32/1/2020
On April 22, 2024, UnitedHealth Group issued a press release, providing an update on the Change Healthcare cybersecurity incident that occurred on Feb. 21, 2024. Given the size of the data impacted, the investigation to determine whose data is impacted is expected to take several months. UnitedHealth Group believes this situation will impact “a substantial proportion of people in America” and is offering immediate credit monitoring and identity protection services, as well as a dedicated contact center to address questions. Visit Change Healthcare Cyberattack Support and/or reach out to the contact center at 1-866-262-5342 regarding any questions.