Provider Appeals

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 65 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 file 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 or reduction in payment
• Waiver of Liability Form (required from non-contract providers for Medicare appeals)
• Supporting documentation that should be considered with the appeal, 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, mailing address, and telephone number for the person filing the appeal

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

Upper Peninsula Health Plan
Attn: Clinical Services – Appeals
853 W. Washington Street
Marquette, MI 49855
Fax: 906-225-7720

What happens next?

UPHP will process your appeal and respond in writing no later than 60 calendar days from the date UPHP received the valid reconsideration request. UPHP will complete outreach via phone and/or in writing to the person who filed the appeal if more information is needed to process the appeal.

You may click on the links below for further details:

300-031 Medicaid Provider Claim Appeals

600-320 Medicare Provider Appeals 

800-318 MI Health Link Provider Claim Appeals

Waiver of Liability Form