Medicaid SSI & BadgerCare Plus Appeals

Medicaid SSI & BadgerCare Plus Appeals


If you are asking to appeal a decision for your Medicaid SSI or BadgerCare Plus benefits, a written request must be postmarked within 45 calendar days from the date of the denial letter.

You have three options for an appeal. You may choose: a local appeal, DHS Review, and/or a Fair Hearing. You may begin with any of these three options. But you cannot request a local appeal after completing a DHS Review or Fair Hearing.

Two Types of Local Appeals:

Standard: Standard appeal decisions are made no later than 30 calendar days from receiving the request for an appeal. Independent Care may extend the timeframe up to 14 calendar days if you request the extension or if iCare is able to justify that an extension is in your best interest.

Expedited (fast) Appeal:You can ask for an expedited appeal if you feel your health could be in jeopardy by waiting the standard timeframe. Expedited appeals can be transferred to the standard timeframe if it is determined your life is not in serious jeopardy. Independent Care will decide whether the appeal qualifies as expedited within 2 business days. If the request for a fast appeal is denied, you will be notified in writing of your right to file an expedited grievance.

If iCare agrees that your appeal should be expedited, it will follow the same steps as a standard appeal. The appeal process will be completed within 72 hours from receiving the appeal request.

Standard appeals must be submitted within 45 calendar days from the date on the denial notice by writing to:

  • Quality Improvement Department
  • Attention: Member Appeals
  • Independent Care Health Plan
  • 1555 N. RiverCenter Dr. Ste. 206
  • Milwaukee, WI 53212-3958
  • Fax: 414-918-7592

  • If you need help writing your appeal request, please contact the Member Advocate at: 414-231-1076.
  • Or
  • You can call Disability Rights Wisconsin at: 414-773-4646 or 800-708-3034.
  • Or
  • You can call the Wisconsin Medicaid Managed Care Ombudsman at 1-800-760-0001.

What Happens Next?

  • Step 1: Within 5 calendar days you will receive an acknowledgment letter confirming your appeal has been received
  • Step 2: Within 30 calendar days of receiving your appeal iCare will investigate and make all reasonable efforts to gather additional information relevant to your appeal
  • Step 3: An Appeal Committee meeting is scheduled. Members are encouraged to attend the appeal meeting and speak with the Committee
  • Step 4: After the Committee reviews all of the information, and speaks to the member if they want to participate, a decision is made to either approve or deny the benefit
  • Step 5: If the Committee determines to approve the service, iCare will authorize the service in dispute
  • Step 6: If the committee determines to deny the benefit, you can ask the state to review the denial or request a Fair Hearing
  • You will receive written notification of the final decision

DHS Review

To ask the State to review our decision you can call 1-800-760-0001 or write to:

  • Wisconsin Medicaid
  • Managed Care Ombudsman
  • P.O. Box 6470
  • Madison, WI 53716-0470

Fair Hearing

You can ask for a fair hearing by sending a written request to:

  • Department of Administration
  • Division of Hearings and Appeals
  • P.O. Box 7875
  • Madison, WI 53707

Modified: 6/7/2019
 

  • H2237_IC2029
 
  • Independent Care Health Plan
  • 1555 RiverCenter Drive, Suite 206
  • Milwaukee, WI 53212
  • Customer Service: 1-800-777-4376
    • 24 hours-a-day, 7 days-a-week
    • (Office Hours: Monday-Friday, 8:30 a.m. to 5:00 p.m.)
  • TTY: 1-800-947-3529
  • Fax: 414-231-1092
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