UPHP

Provider Appeals

Attention Providers: Effective January 1, 2019, all Michigan and UPHP network providers who treat UPHP Medicaid, Healthy Michigan Plan, and Children’s Special Health Care Services members must be enrolled in CHAMPS in order to receive payment. If you receive a claim denial of CPEV (CHAMPS provider enrollment verification) or CO279 (Services not provided by Preferred network providers) - please contact UPHP Claim Services at 906-225-7746 for more information.

Upper Peninsula Health Plan Provider Appeal Rights

What if I don’t agree with this decision?

You have the right to appeal a denial or reduction in payment for covered services made by Upper Peninsula Health Plan (UPHP). You must submit your appeal to UPHP no later than 60 calendar days from the date on the remittance notice. If you miss the deadline and have good reason for missing it, we may give you more time to make your appeal.

How do I file an appeal?

Your request for an appeal must be submitted in writing explaining the basis for the appeal and include the following:

Member name
Member identification number
Remittance notification showing the denial
Signed Waiver of Liability (non-contract providers for Medicare Appeals)
Supporting documentation such as proof of timely filing, medical records, reason for not obtaining authorization, or other information that supports the appeal or is pertinent to the appeal
The name, address, and telephone number of the person responsible for filing the appeal

All provider appeal requests are to be mailed or faxed to:

Upper Peninsula Health Plan
Attn: UM Review and Appeals Coordinator
853 West Washington Street
Marquette, MI 49855
Fax: 906-225-7720

What happens next?

UPHP will process your reconsideration request and respond in writing within 60 calendar days.

You may click on the links below for further details:

300-031 Medicaid Provider Appeals

600-320 Medicare Provider Appeals

800-318 MI Health Link Provider Appeals

Waiver of Liability Form