Failure to Provide Verification of Level of Care (LOC) or Medical Necessity (MN)

If an application is denied for failure to provide verification of LOC or MN and all other eligibility criteria are met:

Reopen and re-evaluate eligibility using the previously submitted application if verification of LOC or MN is received within 90 days of the date of denial. A written request to reopen is not required. The date the verification is received is the new file date.

If additional information is needed to make an accurate eligibility determination based on the new file date, request the needed information following regular policy and processes.