Table 23-1, Provider Complaint/Grievance Procedures

TABLE 23-1, PROVIDER COMPLAINT/GRIEVANCE PROCEDURES
EMBLEMHEALTH MEDICARE HMO AND PPO PLANS
BENEFIT PLAN(S)	WHAT/HOW/WHERE TO FILE HARD COPY **: INSTRUCTIONS	TIME FRAMES*			ADDITIONAL RIGHTS
BENEFIT PLAN(S)	WHAT/HOW/WHERE TO FILE HARD COPY **: INSTRUCTIONS	Initial Practitioner Filing	EmblemHealth Acknowledges Receipt	EmblemHealth Determination Notification	ADDITIONAL RIGHTS
EmblemHealth Medicare HMO Plans	Sign in to: www.emblemhealth.com. Write to: EmblemHealth Medicare HMO P.O. Box 2807 New York, NY 10116-2807	45 calendar days from event. Exceptions:SUNY Downstate - 90 calendar days from event; Stony Brook Affiliations - 120 calendar days from event.	15 calendar days from receipt of request.	Complaint: 30 calendar days from receipt of request. Grievance: 45 calendar days from receipt of request.	Decision is final.
EmblemHealth Medicare PPO Plans	Sign in to: www.emblemhealth.com. Write to: EmblemHealth Medicare PPO PO Box 2807 New York, NY 10116-2807	45 calendar days from event.	15 calendar days from receipt of request.	Complaint: 30 calendar days from receipt of request. Grievance: 45 calendar days from receipt of request.	Decision is final.

* Contracted facility time frames in provider agreements will supersede time frames in this manual.

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