This version of the form is not currently in use and is provided for reference only. Download this version of Form ODM01959 for the current year.
This is a legal form that was released by the Ohio Department of Medicaid - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is ODM01959?
A: ODM01959 is an Appeal Summary for Managed Care Plans in Ohio.
Q: What is an appeal?
A: An appeal is a request for a review of a decision made by a managed care plan in Ohio.
Q: Who can file an appeal?
A: Any enrollee or their authorized representative can file an appeal.
Q: How do I file an appeal?
A: To file an appeal, you should follow the instructions provided in ODM01959 and submit it to the appropriate managed care plan.
Q: What information should be included in the appeal?
A: The appeal should include your name, contact information, the reason for the appeal, and any supporting documentation.
Q: Can I have assistance in filing an appeal?
A: Yes, you can seek assistance from an advocate or other authorized representative in filing an appeal.
Q: What happens after I file an appeal?
A: The managed care plan will review your appeal and make a decision. You will be notified of the outcome.
Q: What if I disagree with the decision made by the managed care plan?
A: If you disagree with the decision, you have the right to request a State Fair Hearing.
Q: Is there a deadline for filing an appeal?
A: Yes, there is a deadline for filing an appeal. Please refer to ODM01959 for the specific deadline for your case.
Form Details:
Download a fillable version of Form ODM01959 by clicking the link below or browse more documents and templates provided by the Ohio Department of Medicaid.