This version of the form is not currently in use and is provided for reference only. Download this version of Form DMHC20-224 for the current year.
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.
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.
Form Details:
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.