Grievances and Appeals Management

For grievances and appeals, please print and complete the document below that applies to your location. In order to submit the appeal, please include a letter justifying the appeal and make sure all documents are complete, legible, signed by the corresponding physician, and contain the reason(s) for the appeal.

Appeals should be received within 180 days from the date the patient received the notification of denial.

• For U.S. Mainland - Appeals should be sent via fax to 1-866-387-3487 or by mail to:

MC-Rx Clinical Division

1267 Professional Parkway,

Gainesville, GA 30507

• For Puerto Rico - Appeals should be sent via fax to 1-866-827-8024 or by mail to:

Client Services Department, MC-Rx

Call Box 4908,

Caguas, PR 00726

Documents will be evaluated and a reply will be sent following receipt.

Download Physician Prior Authorization Form