Helping you manage
all the moving pieces

Your Anthem HealthKeepers Medicare-Medicaid Plan (MMP), a Commonwealth Coordinated Care plan, won’t be offered in 2018. But don’t worry, we’re here to help.

Your Medicaid benefits for 2018

You don’t have to do anything to keep your Medicaid benefits. On January 1, 2018, you’ll be enrolled into our Anthem CCC Plus plan. Find out more at www.anthem.com/vamedicaid.

You have other options for your Medicare benefits.

Our Anthem HealthKeepers MediBlue Dual Advantage (HMO SNP) plan has benefits, services and a provider network much like those you had with Anthem HealthKeepers MMP. You may be eligible for this plan if you live in our service area. Just call us at 1-855-548-2647 to find out more about our program and your Medicare plan options.

Share your thoughts with us

What you think about our plan matters to us. Is there something you like or dislike about our services? Do you have questions and need help with your health plan or pharmacy benefits? If so, please call Member Services.

If you feel you have used all your options with us, you may submit a Medicare complaint form at Medicare.gov.


Grievances and Appeals

What is a grievance?

You have the right to file a grievance, a complaint about our plan that doesn’t involve coverage or payment for a drug or a service covered by the plan.

How do I file a grievance?

Call Member Services at 1-855-817-5787 (TTY 711) Monday through Friday from
8 a.m. to 8 p.m. Eastern time. You can also send a grievance in writing:

Mail to:
Complaints, Appeals and Grievances
HealthKeepers, Inc.
Mailstop: OH0205-A537
4361 Irwin Simpson Road
Mason, OH 45040
Fax to: 1-888-458-1406

Please include your name and member ID number on the written appeal.


What is an appeal?

An appeal is when you ask us to cover a medicine or a service after we said we wouldn’t.

How do I file an appeal?

You must file an appeal within 60 days of the coverage decision.

Call Member Services at 1-855-817-5787 (TTY 711) Monday through Friday from 8 a.m. to 8 p.m. Eastern time. You can also send an appeal in writing:
Complaints, Appeals and Grievances
HealthKeepers, Inc.
Mailstop: OH0205-A537
4361 Irwin Simpson Road
Mason, OH 45040
Fax to: 1-888-458-1406


Please include your name and member ID number on the written appeal.

If your appeal is about:

  • A Part D drug — You’ll get a decision in 7 calendar days.
  • A non-Part D drug, a Medicare-covered service, or a Medicaid-covered service — You’ll get a decision in 30 calendar days. We can also take up to 14 extra calendar days if we need more information.
  • A payment – You’ll get a decision in 60 calendar days.
What if I need a fast (expedited) decision on my appeal?

You must file an appeal within 60 days of the coverage decision.


Call Member Services at 1-855-817-5787 (TTY 711) Monday through Friday from 8 a.m. to 8 p.m. Eastern time. You can also send your request in writing:
Complaints, Appeals and Grievances
HealthKeepers, Inc.
P.O. Box 61116
Mailstop: OH0205-A537
4361 Irwin Simpson Road
Mason, OH 45040
Fax to: 1-888-458-1406
Please include your name and member ID number on the written appeal.
You’ll receive information about the status of your request within 72 hours.

What should I include with my appeal?

If your appeal is about a Part D drug, include:

  • The appeal form included in the denial letter. You can also get a copy by calling Member Services at 1-855-817-5787 (TTY 711) Monday through Friday from 8 a.m. to 8 p.m. Eastern time or visiting our website.
  • Any information (documents, medical records) to support your appeal
  • An Appointment of Representative (AOR) form if a person other than you or your prescribing physician is appealing on your behalf
  • Your name and member ID number on the written appeal.

If your appeal is about a non-Part D drug:

  • You don’t need a special appeal form. Just submit your reason in writing or call Member Services at 1-855-817-5787 (TTY 711) Monday through Friday from 8 a.m. to 8 p.m. Eastern time.
  • Include information (documents, medical records) to support your appeal
  • Include an Appointment of Representative (AOR) form if you choose to have someone else submit the appeal on your behalf
  • Include your name and member ID number on the written appeal.
What can I do if the appeal decision is unfavorable?

If your appeal was about a Part D drug:

If we don’t decide in your favor, your case is auto-forwarded to the independent review entity (IRE). We’ll send you a letter to tell you if this happens. You will have to reach out directly to the IRE at this stage of the process.

MAXIMUS Federal Services, Inc.
Medicare Managed Care & PACE Reconsideration Project
3750 Monroe Avenue, Suite 702
Pittsford, NY 14534-1302

Fax:585-425-5292
Phone: 585-348-3300


If your appeal was about a non-Part D drug:

Our decision will be filed with the IRE. You’ll get the contact information on the letter we send you about our decision. You may also ask the Department of Medical Assistance Services (DMAS) appeals division for a State Fair Hearing. You can call or submit it in writing via fax, mail, hand delivery, or electronic submission within 60 days of the health plan determination.

Appeals Division
Department of Medical Assistance Services
600 E. Broad Street
Richmond, VA 23219

Phone: 804-371-8488
Fax:804-371-8491


If your appeal was about a Medicare-covered service:

If we don’t decide in your favor, your case is auto-forwarded to the independent review entity (IRE). We’ll send you a letter to tell you if this happens. You will have to reach out directly to the IRE at this stage of the process.

MAXIMUS Federal Services, Inc.
Medicare Managed Care & PACE Reconsideration Project
3750 Monroe Avenue, Suite 702
Pittsford, NY 14534-1302

Fax: 585-425-5292
Phone: 585-348-3300


If your appeal was about a Medicaid-covered service:

Your appeal will need to be filed through the DMAS Appeals Division. You can call or submit it in writing via fax, mail, hand delivery, or electronic submission within 60 days of the health plan determination.

Appeals Division
Department of Medical Assistance Services
600 E. Broad Street
Richmond, VA 23219

Phone: 804-371-8488
Fax: 804-371-8491


Note: If there is an adverse determination for a service covered by both Medicare and Medicaid, it will be auto-forwarded to the IRE, and you may also ask the DMAS Appeals Division for a State Fair Hearing. If both the IRE and the state make decisions, we’ll follow the decision that is most favorable to you


To find out how many appeals, grievances, and exceptions have been filed with our plan or to get the status of your request, call Member Services.