Commercial and Medicare Plans |
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BENEFIT PLAN(S) |
WHAT/HOW/WHERE TO FILE: |
TIME FRAMES |
ADDITIONAL RIGHTS |
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Initial Member/ |
ConnectiCare Acknowledges Receipt |
ConnectiCare Determination Notification |
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ConnectiCare |
Unless otherwise directed in the denial
ConnectiCare Telephone: |
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 |
External appeal if applicable |
ConnectiCare of Massachusetts
|
Telephone: |
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 |
External appeal |
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Table 21-11, Clinical Appeal - Standard
