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To ask for a health plan appeal, you can call Driscoll Health Plan at: 18773247543, email: DHP_QM_Appeals@dchstx.org, or you can fill out this form and mail or fax it to us.Driscoll Health Plan Quality
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How to fill out um-006a-appeal-request-form

01
Obtain a copy of the UM-006A appeal request form from the appropriate source.
02
Fill in your personal information, including your name, address, and contact details.
03
Provide details about the decision you are appealing, including the date of the decision and any reference numbers.
04
Clearly explain the reasons for your appeal and provide any supporting documentation or evidence.
05
Sign and date the form before submitting it to the relevant authority.

Who needs um-006a-appeal-request-form?

01
Individuals who have received a decision that they disagree with and wish to appeal.
02
Those who have the right to challenge a decision and seek a review or reconsideration.

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The UM-006A Appeal Request Form is a document used to appeal decisions made by certain administrative bodies or organizations, allowing individuals or entities to request a review of a previous decision.
Individuals or entities who wish to contest a decision regarding their case or application that falls under the jurisdiction of the relevant authority are required to file the UM-006A Appeal Request Form.
To fill out the UM-006A Appeal Request Form, provide accurate details including your personal or organizational information, the specific decision being appealed, the grounds for the appeal, and any supporting documentation as required.
The purpose of the UM-006A Appeal Request Form is to formally communicate an individual's or organization's intent to contest a decision, facilitating a review process by the appropriate authority.
The form must include personal details, information about the decision being appealed, reasons for the appeal, relevant dates, and any additional required documentation.
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