Filing an Appeal or Grievance with Molina Complete Care (MCC)
There are several ways members or their authorized representative (including a provider on behalf of a member) can file a grievance with MCC:
By phone: (800) 424-5891
Monday-Friday 8 a.m. to 6 p.m. MST.
By email: MCCAZ-PrvDisputes@molinahealthcare.com
By mail: Members or their authorized representative may submit a grievance by mail to:
Molina Complete Care
Attn: Appeals and Grievance Department
5055 E Washington St, Suite 210
Phoenix, AZ 85034
Members or their authorized representative also have the right to file an external grievance against MCC. Grievances against MCC may be filed through the AHCCCS Medical Management Helpline at (602) 417-4000 or (800) 654-8713 outside of Maricopa County.
Finally, members or their authorized representative have the option to also file an external grievance with the Department of Health and Human Services’ Office for Civil Rights if the member believes they have not been treated fairly by MCC. Complaints regarding civil rights issues may be mailed to:
Office of Civil Rights – Region III
Department of Health and Human Services
150 S Independence Mall West Suite 372
Public Ledger Building
Philadelphia, PA 19106
Phone – (800) 368-1019
Fax – (215) 861-4431
Please visit www.hhs.gov/ocr for more information.
Filing an Appeal with MCC
An appeal can be filed within 60 days of the date on the Notice of Adverse Benefit Determination. Once the notice is received, there are several ways an appeal can be filed:
By phone: (800) 424-5891 Monday-Friday 8 a.m. to 6 p.m. MST.
By email: MCCAZ-AppealGrieve@MolinaHealthCare.Com
By mail: Members or their authorized representative may submit a grievance by mail to:
Molina Complete Care
Attn: Appeals and Grievance Department
5055 E Washington St, Suite 210
Phoenix, AZ 85034
If a member or their authorized representative chooses to submit a standard appeal orally, they must also submit the request in writing within 10 days of the date of the oral request. Expedited appeals filed orally do not require a written follow-up.
Standard Appeal Process
MCC will review all documentation received regarding the appeal and will render a determination within 30 days of the appeal request.
Members may request an extension of up to 14 days. MCC may also request an extension of up to 14 days if we require additional information to render a decision. In the event MCC requests an extension, members or their authorized representative are notified both orally and in writing. We will call you and send a written notice within two calendar days explaining the reasoning behind extending the timeframe. You have the right to file a grievance if you disagree with the extension.
If the member or their authorized representative does not agree with MCC decision regarding the appeal, they may request a State Fair Hearing.
Expedited Appeal Process
If the member or their authorized representative feels that they need an immediate decision, they may request an expedited appeal. Once MCC has all of the information needed, we will provide a determination within 72 hours of the request.
If MCC determines that the appeal should not be expedited, we will inform the member of the downgrade both orally and via written notice within two calendar days indicating the reason for the decision. MCC will then resolve the appeal within the standard appeal timeframes.
The member or their authorized representative may request an extension of up to 14 days. MCC may also request an extension of up to 14 days if we require additional information to render a decision. In the event MCC requests an extension, members or their authorized representative are notified both orally and in writing. We will call you and send a written notice within two calendar days explaining the reasoning behind extending the timeframe. The member or authorized representative has the right to file a grievance if they disagree with the extension.
If the member or authorized representative does not agree with MCC’s appeal determination, they may request an expedited State Fair Hearing.
State Fair Hearing Request
If the member or their authorized representative do not agree with MCC’s decision regarding their appeal, they may request a State Fair Hearing in writing within 120 days from the date on the Notice of Appeal Resolution sent to them.
Information about how to request a State Fair Hearing is included in the Notice of Appeal Resolution.
To request a State Fair Hearing in writing, please send a letter to:
Molina Complete Care
Attn: Appeals and Grievance Department
5055 E Washington St, Suite 210
Phoenix, AZ 85034
Continuation of Care
A member or authorized representative may request a continuation of care within 10 calendar days of the Adverse Benefit Determination Notice or intended date of the Adverse Benefit Determination Notice. Requests for continuation are considered if the appeal involves the following:
- Termination, suspension or reduction of a previously authorized service
- A denial of service(s) which the provider asserts that the service(s) or treatment(s) is/are a necessary continuation or a previously authorized service
- The services were requested by an authorized provider and at the time the appeal was filed, the original authorization had not expired
Please note that MCC may recover the cost of continued services if the final resolution of the appeal or State Fair Hearing upholds our denial.
Provider Claims Disputes
Providers may challenge a claim payment, denial or recoupment through the claim dispute process. Claim disputes must be filed in writing no later than 12 months from the date of eligibility posting, or within 60 days after the payment, denial or recoupment of a timely claim submission, whichever is later. Claim disputes must provide the factual and legal basis for the dispute and the relief requested.
Claim disputes may be emailed to MCCAZ-AppealGrieve@MolinaHealthCare.Com or sent by mail to:
Molina Complete Care
Attn: Provider Claim Disputes
5055 E Washington St, Suite 210
Phoenix, AZ 85034
Unless agreed to by MCC and the provider, we will provide a written determination within 30 calendar days of the dispute receipt date.
It is important to note that correspondence received specifically indicating a request for the reconsideration or resubmission of a claim will be forwarded directly to MCC’s claims department for review and determination.
If the provider does not agree with MCC’s claim dispute determination, they may request a State Fair Hearing.
State Fair Hearing Request
If a provider does not agree with MCC’s decision regarding their appeal, they may request a State Fair Hearing in writing within 30 calendar days from the date on the Notice of Decision sent to them. Information about how to request a State Fair Hearing is included in the Notice of Determination.