Provider Appeals Resources

Overview

Providers, individuals, or entities that have a contract with DMAS to provide services may appeal any DMAS action subject to appeal under the applicable laws and regulations, including issues related to reimbursement for covered services, DMAS's interpretation and application of payment methodologies and provider enrollment. As part of the appeal process, an impartial representative will conduct a review to determine whether the action proposed or taken was correct. The end result of the appeal is a written decision. Formal appeal decisions by the DMAS Director may be appealed to court for review of the record.