| 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 |
||
Initial |
EmblemHealth Acknowledges Receipt |
EmblemHealth Determination Notification |
|||
EmblemHealth Medicare HMO Plans |
Sign in to emblemhealth.com/providers and use My Messages under username drop-down Write to: |
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 emblemhealth.com/providers and use My Messages under username drop-down Write to: |
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.
