MedicaidAdministrativeMedium impact
Denial/Appeal Letter Template
Maryland Medicaid·MD·Managed Care Organizations
Effective date
Sep 15, 2003
We identified it
Jun 20, 2026
Summary
Maryland has provided a standardized template for Managed Care Organizations to use when sending denial and appeal letters to Medicaid enrollees. The template includes 11 required elements that must be included in all adverse action letters to ensure compliance with federal regulations and state requirements.
Action Required
Review current denial letter templates to ensure they include all 11 required elements specified in the Maryland template. Update denial letter processes to include clear explanations of denial reasons, criteria used, enrollee rights, and proper contact information for appeals. Ensure all denial letters are copied to the PCP and HealthChoice Complaint Resolution Unit.