State Hearing and External Review
Administrative Law Hearing
Not happy with the internal appeal decision? You may ask for an Administrative Law Hearing. This is the next formal step. It involves you or your representative, CareSource, and an administrative law judge. It will further review the previous decision. You must file within 120 calendar days of the Notice of Adverse Action’s date. This must be done in writing.
Please call us if you have any questions. You may also write to us at:
CareSource
Administrative Law Hearing – Georgia
P.O. Box 1947
Dayton, OH 45401
PeachCare for Kids® members are not able to have benefits during an appeal. They can also not have an administrative law hearing. See below.
External Review for PeachCare® for Kids Members Only
PeachCare for Kids® State Review
Do you not agree with the appeal decision? You may ask for an external review. This is through the Formal Grievance Committee. This is part of the Department of Community Health (DCH). This can be done by you, a parent/guardian, or other representative. This means it is a person you allow to make health choices for you. We must have this person on record in writing. You must go through CareSource’s internal appeal steps first.
You must ask for an external review within 120 days of getting CareSource’s finding. Reviews are done within 90 days for standard reviews or within 72 hours for expedited (fast) reviews. This will be final and CareSource will follow it.
Mail to:
PeachCare for Kids®
Independent Medical Review Request
Georgia Department of Community Health
Division of Medical Assistance
2 Martin Luther King Jr. Drive, SE
19th Floor, East Tower
Atlanta, GA 30334
Need help?
Call us at 1-855-202-0729 (TTY: 711). We can help at no cost to you. We can make it clearer in English or send it in your first language. We can also help you if you have issues seeing or hearing. Please also read your Handbook about your rights.
Member Services: 1-855-202-0729 (TTY: 1-800-255-0056 or 711), Monday – Friday 7 a.m. – 7 p.m.