Denial of MDAAP Incentive
In the event an MDAAP applicant is denied an incentive payment, the applicant will receive a denial of MDAAP incentive notification letter sent by email to the provider/practice. The letter will include a description of the results of the review, including any identified discrepancies and findings about program eligibility and documentation requirements. Included in the notification will be instructions on how to submit a request for reconsideration, the first level of our appeals process. The provider will have 30 days from the receipt of the letter to file for reconsideration.
MDAAP Reconsideration & Appeal Process
The Medicaid Data Aggregation and Access Program (MDAAP) offers a Reconsideration and Appeal process that aligns with that of the Vermont Medicaid program, and is detailed in Section 8 of the Green Mountain Care General Provider Manual, available here: https://www.vtmedicaid.com/assets/manuals/GeneralProviderManual.pdf
Reconsideration of MDAAP Decisions
Providers may request Reconsideration of a MDAAP decision regarding eligibility for: payment amount, overpayment amount, or recoupment. The request must be made within thirty (30) calendar days of the receipt of the overpayment notice OR of the denial notice OR within thirty (30) calendar days of the date of the MDAAP payment in dispute. The request must be filed on the Request for MDAAP Reconsideration form (below).
Please follow the instructions in the Green Mountain Care General Provider Manual and note that all requests are sent to:
Office of the General Counsel
MDAAP Appeals
Department of Vermont Health Access
280 State Drive, NOB 1 South
Waterbury, VT 05671-1010
Forms:
Request for MDAAP reconsideration form
Request for appeal of MDAAP reconsideration form