Clear Impact logo

Appeals Unit

What We Do

The Health Care Appeals Team (HCAT) is responsible for both covered services and eligibility appeals and fair hearing processes.  It coordinates the internal covered services appeal process on standard and expedited timeframes.  It also processes and, where possible, resolves requests for fair hearings on eligibility determinations.

Who We Serve

The Health Care Appeals Team (HCAT) serves all Medicaid members as well as Qualified Health Plan (QHP) members.

How We Impact

The Health Care Appeals Team (HCAT) facilitates the process for members to address issues with their coverage or eligibility.  This not only benefits individual members, but it enables system-wide improvements by identifying patterns and working with other units to prevent issues from arising again.

Action Plan

SFY23 priorities are:

  • Continue to resolve 50% appeals prior to hearing
  • PHE Unwind
  • Meet established SLA timelines

Measures

Time
Period
Current Actual Value
Current Target Value
Current
Trend
Baseline
% Change

Clear Impact Suite is an easy-to-use, web-based software platform that helps your staff collaborate with external stakeholders and community partners by utilizing the combination of data collection, performance reporting, and program planning.

Scorecard Container Measure Action Actual Value Target Value Tag S A m/d/yy m/d/yyyy