Professionals

The Fast-Track Appeals Process

Whenever a patient is discharged (or services are stopped) from an inpatient hospital, home health agency, skilled nursing facility, comprehensive outpatient rehabilitation facility or hospice, they should receive a notice that tells them how to request an appeal. If the patient or their representative believes that their services are ending too soon, they can call Qualidigm for an expedited review of the plan or provider decision. Our professional staff will look at each case and decide if the services are eligible to continue under Medicare coverage.

Medicare Advantage plans contract with Medicare to provide managed health care services to Medicare members. Beneficiaries enrolled in a Medicare Advantage plan have the right to call Qualidigm toll-free at 1.800.553.7590 to appeal their plan’s decision to stop coverage of services from an inpatient hospital, home health agency, skilled nursing facility, comprehensive outpatient rehabilitation facility or hospice.

Timing is important. The notice from the health care provider or the Medicare Advantage plan will give the date when services will end. For an expedited review, Qualidigm should be contacted immediately. If the timeframe for filing a fast-track appeal is missed, the notice will state other appeal rights available through the Medicare Advantage plan.

A fast-track appeal can be requested by calling Qualidigm toll-free at 1.800.553.7590, Monday through Sunday 8:30 am to 4:30 pm.  A message can be left at any time of the day or night.

Access tools and resources related to this topic at the Centers for Medicare & Medicaid Services (CMS) website.