Table 21-11, Clinical Appeal - Standard

Commercial and Medicare Plans

BENEFIT PLAN(S)

WHAT/HOW/WHERE TO FILE:

INSTRUCTIONS

TIME FRAMES

ADDITIONAL RIGHTS

Initial Member/
Provider* Filing

ConnectiCare Acknowledges Receipt

ConnectiCare Determination Notification

ConnectiCare

Unless otherwise directed in the denial 
letter, write to:

ConnectiCare
Grievance and Appeal Dept.
P.O. Box 4061
Farmington, CT  06034

Telephone:
800-251-7722

60 calendar days for Medicare and 180 calendar days for commercial from receipt of written adverse determination

15 calendar days from the receipt of the request for Medicare

30 calendar days from receipt for pre-service requests

60 calendar days from receipt of request for post-service requests

External appeal if applicable

ConnectiCare of Massachusetts

ConnectiCare
Grievance and Appeal Dept.
P.O. Box 4061
Farmington, CT  06034

Telephone:
800-251-7722

60 calendar days for Medicare and 180 calendar days for commercial from receipt of written adverse determination

15 calendar days from the receipt of the request for Medicare

30 calendar days from receipt for pre-service requests

60 calendar days for Medicare and 30 calendar days for commercial from receipt of request for post-service requests

External appeal