FOR DENIALS BASED ON "NO INFORMATION" | |||||
WHEN MEMBERS ARE ALREADY DISCHARGED | |||||
BENEFIT PLAN(S) |
WHAT/HOW/WHERE TO FILE INSTRUCTIONS |
TIME FRAMES |
ADDITIONAL RIGHTS |
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Initial Facility Filing |
EmblemHealth Acknowledges Receipt |
EmblemHealth Determination Notification |
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All HIP and EmblemHealth CompreHealth EPO |
Unless otherwise directed in the denial letter, write to: EmblemHealth Telephone: |
45 calendar days from receipt of written adverse determination. |
15 calendar days from receipt of necessary information |
For members already discharged or "no information" denial: 5 business days from determination. For no E.R. notification: Within 2 business days of determination. 60 calendar days. (30 days for PPO accounts) Both member and provider notified within 2 business days of |
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GHI HMO |
For members already discharged: For "no information" denial or no E.R. |
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GHI PPO and EmblemHealth PPO/EPO |
Unless otherwise directed in the denial letter, write to: GHI or EmblemHealth Telephone: Fax to: |
Member: 180 calendar days from receipt of written adverse Provider: 45 calendar days from the claim denial, unless specified otherwise by your contract with HIP. |
15 calendar days from receipt of |
60 calendar days from receipt . (30 days for PPO accounts) Both member and |
External appeal |