![]() ![]() The Appeal and Grievance department will thoroughly research and seek input from other departments, if necessary. ![]() We’ll respond to standard provider appeals within 30 calendar days. Post-service items are always standard appeals and aren’t eligible for expedited processing.Įmail: acknowledge your appeal verbally or in writing within 5 business days of receipt. You’ll want to do so within 60 calendar days of the claim processing date. If you’re not satisfied with the outcome of a dispute, you can file an appeal in writing. When filing an appeal or grievance, you’ll receive an appeal or grievance number in the acknowledgment and resolution letters (for example, APXXXX or GRXXXX). This is part of HFS’ rules.ĭuring the process, we’ll assign the dispute a reference number for tracking. If you feel we didn’t address the dispute adequately, use the MCO tracking number to file a complaint with HFS.ĭispute by phone: Just call us at 1-86 (TTY: 711). The agent will give you a tracking/reference number (for example, #PDXGR1234567).ĭispute to Network Relations: The consultant will give you a reference number (for example, #1234).ĭispute or reconsideration by mail or Provider Portal: Complete the requested info and attach or upload any supporting documentation. We’ll send the dispute decision in a provider remittance. The tracking/reference number is the adjusted claims number from that remittance (that is, the claim number ending in A1, A2, A3, etc.). Before you file a complaint with the Illinois Department of Healthcare and Family Services (HFS), you’ll need to complete the managed care organization (MCO) dispute process.
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