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Complaints and Appeals

Your voice is very important to us and we welcome your

  • Opinions
  • Concerns
  • Complaints
  • Grievances or recommendations. 

Please use the Grievance, Appeal or Concern Form or call Member Services at 1-844-366-2880 or TTY/TDD 1-844-804-6086 Rely 711. If you have been denied a service that you feel you should receive. please notify us as soon as possible.

HOW TO FILE A GRIEVANCE

You can file a grievance in the way that works best for you:

SilverSummit Healthplan
ATTN: Grievances
2500 North Buffalo Drive, Suite 250
Las Vegas, NV 89128

What to Include:

Please give us this information:

  • Your name
  • Your Nevada Medicaid ID number
  • Your address and phone number
  • What happened and why you’re unhappy
  • What you would like us to do

There’s a form in the handbook that can help you. You don’t have to use it, but it shows what information we need.

What Happens Next

  • We’ll send you a letter within 3 business days to say we got your grievance.
  • We’ll keep a copy of your grievance and our response for 10 years.
  • If someone else is filing for you, we need your written permission. You can use the Personal Appeal Representation Form in the Member handbook.

If you have any papers or proof to support your grievance, please send them to us. Please know there is a limited time for you to send in this proof. You can also ask for copies of anything we used to make our decision—for free.

When You’ll Hear Back

We’ll try to fix the problem as fast as we can. If it’s urgent, please tell us. You’ll get a letter from us within 45 calendar days with our decision. We may also try to call you. If we need more time, we may ask Nevada Medicaid or Nevada Check Up for an extension. If they say yes, we’ll tell you why and send you a letter within 2 days.

You can also ask for more time—14 extra days—if you need it. Just call Member Services and ask for the appeals department. If you don’t agree with the extra time, you can file another grievance. We will never treat you unfairly for speaking up. We want to hear your concerns so we can do better. For additional information, please see the handbook.

Appeals: Asking Us To Look Again

An appeal is when you ask us to look again at a decision we made about your care. You can file an appeal if we:

  • Say no to care you asked for 
  • Approve less care than you need
  • Stop care that was already approved 
  • Say we won’t pay for care you might have to pay for These are called adverse benefit decisions. If this happens, we’ll send you a letter explaining what we decided and why. You have 60 days from the date on that letter to file an appeal.

You can also ask for copies of the records or any information we used to make our decision. These are free. We keep these records for 10 years. We will not treat you differently if you file an appeal. 

HOW TO FILE AN APPEAL

You have the right to look at your case file, including your medical records, before and during the appeal.

You can file an appeal by:

  • Calling Member Services: 1-844-366-2880, TTY: 1-844-804-6086, Relay 711
  • Filling out the appeal form in the back of this book
  • Sending a letter
  • Faxing the form or letter
  • Asking in person

Send appeals for physical health or pharmacy services to:

SilverSummit Healthplan
ATTN: Appeals
2500 North Buffalo Drive, Suite 250
Las Vegas, NV 89128

Fax: 1-855-742-0125

Send appeals for mental health or substance use services to:

SilverSummit Healthplan
ATTN: Appeals
12515-8 Research Blvd., Suite 400
Austin, TX 78759

Fax: 1-866-714-7991

You don’t have to use the form, but it helps show what information we need.

Send appeals for imaging to:

Evolent Specialty Services, Inc.
Appeals Department
P.O. Box 361
Portland, ME 04104

Phone 1-866-972-9842 / TTD/TTY 711 / Fax: 1-888-656-0701

What Happens After You File

After we get your appeal, we’ll send you a letter to let you know we received it. The letter will also tell you the last day you can send us more information.

You can give us more details like:

  • Medical records
  • Proof or facts
  • Legal reasons

There’s a time limit, so check the date in your letter.

Member Services: 1-844-366-2880 • TTY: 1-844-804-6086, Relay 711

We’ll send you a decision within 30 days. We may also try to call you to explain the decision.

If we need more time, we may ask Nevada Medicaid or Nevada Check Up for an extension. If they say yes, we’ll send you a letter and try to call you.

You can also ask for 14 more days if you need more time. Just call Member Services and ask for the appeals department.

If you don’t agree with the extra time, you can file a grievance.

Need Help?

We can help you:

  • Fill out forms
  • Set up a ride to your appeal hearing
  • Get an interpreter
  • Use TTY/TDD services

You and your helper can look at your case file before and during the appeal. This is free and will be sent in time for your appeal. For additional information, please refer to your 2026 SSHP NV Medicaid Member Handbook.