An appeal is how you ask us to review our actions. You might get a decision letter telling you that a service is ending. You can appeal if you disagree. You must ask for one within 60 days from the date listed on the letter. You or an authorized representative can file.

  • Call Member Services at 1-833-230-2005 (TDD/TTY: 711) to tell us. We can also mail you a form to send back.
  • Fill out the Navigate Grievances and Appeals form.
  • Mail us a letter. Mail the letter to:
    CareSource PASSE
    Attn: Member Grievances
    P.O. Box 1947
    Dayton, OH 45401-1947

Who can ask for an appeal?

  • You.
  • Your provider with your written consent.
  • Someone that you say can act on your behalf.
  • Your parent of legal guardian.
  • An attorney with your written consent.

When can you ask for an appeal?

You can ask for an appeal within 60 calendar days of the date listed on the decision letter. We will let you know in writing within 5 business days that we got it. We will give you an answer within 30 calendar days once we get your appeal. You can file an appeal by phone or in writing.

What must your appeal have?

  •  Your name.
  • Your member ID number.
  • The provider’s name.
  • The date of the service.
  • The reason for your appeal.
  • Information you want to attach.
  • A phone number where we can reach you.

Who can help you file your appeal?

Your care coordinator or Member Services can help you file. 

Member Services: 1-833-230-2005 (TDD/TTY: 711) Monday through Friday, 8 a.m. – 5 p.m. CT