Non-Participating Provider Appeals & Disputes


Non-participating providers may request reconsideration of a claim denial. You must request an appeal within 60 days of the date of the remittance advice, and a signed Navigate Waiver of Liability (WOL) statement is required. If you do not submit a signed WOL, the appeal will be dismissed.


HAP CareSource™ MI Health Link (Medicare-Medicaid Plan) pays non-contracted providers as Medicare would have paid for the same service. Non-contracted providers have the right to request a reconsideration of the plan’s denial of payment:

  • Non-contracted providers have 60 calendar days from the remittance notification date to file the reconsideration.
  • Non-contracted providers should include documentation such as a copy of the original claim, the remittance notification showing the denial, any clinical records and other documentation that supports the argument for reimbursement.
  • Non-contracted providers must mail the reconsideration within 60 calendar days of the explanation of payment (EOP) date or the remittance notification date, whichever is later, to:
    • HAP CareSource
      Attn: Grievance & Appeals
      P.O. Box 1025
      Dayton, OH, 45401
  • HAP CareSource MI Health Link will review the evidence and respond to the dispute within 60 calendar days.

For more information, contact Provider Services at 1-833-230-2159.

Exhaustion of HAP CareSource MI Health Link Internal Appeals Process

If HAP CareSource MI Health Link and the provider are not able to agree on an association, the rules of the American Arbitration Association shall apply. The arbitrator shall have experience and expertise in the health care field and shall be selected according to the rules of his or her certifying association. Arbitration conducted pursuant to this code shall be binding on the parties. The arbitrator shall conduct a hearing and issue a final ruling within 90 calendar days of being selected, unless HAP CareSource MI Health Link and the provider mutually agree to extend this deadline. All costs for arbitration, not including attorney’s fees, shall be shared equally by the parties. HAP CareSource MI Health Link requires exhaustion of the internal provider compliant/appeal/dispute process prior to requesting an administrative law hearing.