Form DMHC20-224 Independent Medical Review (Imr) Application / Complaint Form - California

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Form DMHC20-224 Independent Medical Review (Imr) Application / Complaint Form - California

What Is Form DMHC20-224?

This is a legal form that was released by the California Department of Managed Health Care - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the DMHC20-224 form?
A: The DMHC20-224 form is the Independent Medical Review (IMR) Application/Complaint Form.

Q: What is the purpose of the DMHC20-224 form?
A: The purpose of the DMHC20-224 form is to request an independent medical review (IMR) in California.

Q: Who can use the DMHC20-224 form?
A: Any California resident who has a problem with their health plan's decision can use the DMHC20-224 form.

Q: What information is required on the DMHC20-224 form?
A: The DMHC20-224 form requires information such as the applicant's contact information, health plan details, and a description of the problem.

Q: Is there a deadline for submitting the DMHC20-224 form?
A: Yes, there is a deadline for submitting the DMHC20-224 form. It must be submitted within 6 months of the health plan's final decision.

Q: What happens after submitting the DMHC20-224 form?
A: After submitting the DMHC20-224 form, the DMHC will review the application and determine if an independent medical review (IMR) is appropriate.

Q: Can I appeal the decision made through the independent medical review (IMR)?
A: No, the decision made through the independent medical review (IMR) is final and cannot be appealed.

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Form Details:

  • Released on January 1, 2020;
  • The latest edition provided by the California Department of Managed Health Care;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DMHC20-224 by clicking the link below or browse more documents and templates provided by the California Department of Managed Health Care.

Download Form DMHC20-224 Independent Medical Review (Imr) Application / Complaint Form - California

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