Appeal Rights and Process

Claims Appeal

A claims appeal is a formal written request from a provider for reconsideration of a claim already processed by Memorial Hermann Health Plan. A written appeal for reconsideration of a denied claim, or a claim the provider believes has been incorrectly paid, should be submitted within 180 days from the date on the Explanation of Payment, along with a copy of the claim and any supporting documentation.

Download and complete the Appeal Reference Form or send a detailed cover letter and mail to:
Memorial Hermann Health Plan
Attention: Appeals
929 Gessner Road
Suite 1500
Houston, TX 77024

Appeal Reference Form

Appeal of Clinical Non-Certification by Medical Management