Department of Medical Assistance Services

Client and Provider Medicaid Appeals
The DMAS Appeals Division is responsible for fairly and impartially providing due process to clients and healthcare providers in full compliance with Virginia law and Medicaid policy. As part of the appeal process, an impartial representative will conduct a review to determine whether the action proposed or taken was correct. The end result of the appeal is a written decision. Client and provider decisions can be appealed to court for review of the record.

Family
Client Medicaid / FAMIS Appeals
Individuals and Families
Individuals have the right to appeal an action that denies, reduces, or terminates Medicaid / FAMIS coverage.
Family
Provider Medicaid Appeals
Healthcare Providers
Providers, individual or entities that have a contract with DMAS to provide services, may appeal any DMAS action subject to appeal under the applicable laws and regulations, including issues related to reimbursement for covered services, DMAS' interpretation and application of payment methodologies and provider enrollment.

Client Appeal Frequently Asked Questions
Client Appeal Overview Resumen del Proceso de Apelación para el Cliente
Client Appeal Request Form Formulario para Cliente para Solicitud de Apelacion
Client Authorized Representative Form Formulario para Cliente para Representante Autorizado
Client Appeal Withdrawal Form Formulario para Cliente para Retirar Apelacion
Provider Appeal Frequently Asked Questions
Provider Appeal Request Form
Provider Authorized Representative Sample Form


Contact


Virginia Department of Medical Assistance Services
Appeals Division
600 E Broad St
Richmond, VA 23219
Phone Number: 804-371-8488
Fax: 804-452-5454