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(2) a complete copy of the recipient’s medical records that support the hospital admission or length of stay and any other supporting documentation; and

(3) a copy of the original noncertification notice and attachments. (d) A provider may request a first-level appeal of a decision that denied or reduced prior authorization under 7 AAC 105 — 7 AAC 160 if, no later than 180 days after the date of that decision, the provider submits a written request for a first-level appeal to the department’s designee. This subsection does not include prior authorizations for services that require certification by a quality improvement organization. The appeal must

(1) specify the basis upon which the decision is challenged and include any supporting documentation; and

(2) include a copy of the original notice of denial of or reduced prior authorization. (e) A provider may request a first-level appeal of a noncertification decision regarding a service that, under 7 AAC 105 — 7 AAC 160, requires certification by a quality improvement organization in order to obtain prior authorization. The provider must submit the appeal to the quality improvement organization no later than 180 days after the date of the noncertification decision. The request for a first-level appeal must be in writing and include

(1) the basis upon which the decision is challenged and any supporting documentation; and

(2) a copy of the original noncertification notice and attachments. (f) A provider may request a first-level appeal of a recoupment of overpayment notice issued under 7 AAC 105.260(c). The provider must submit the appeal to the department’s designee no later than 60 days after the date of the notice and include

(1) a written request for an appeal that specifies the basis upon which the notice for recoupment of overpayment is challenged and any supporting documentation; and

(2) a copy of the recoupment notice under 7 AAC 105.260(c). (g) Except as provided in (l) of this section, a provider that has been denied enrollment by the department or that is disenrolled from Medicaid for a reason other than a reason in 7 AAC 105.400 may appeal the denial or disenrollment under this subsection by submitting

(1) a written request that specifies the basis upon which the decision is challenged and includes any supporting documentation; and

(2) a copy of the original denial of enrollment or notice of disenrollment. (h) A provider making an appeal under (g) of section must submit the appeal no later than 180 days after the date of the decision to deny enrollment or to disenroll the provider to the department at the address listed in the department’s Addresses for Second Level Provider Appeals list, adopted by reference in 7 AAC 160.900. A decision on appeal under (g) of this