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Table 21-13, Facility Clinical Appeal

FOR DENIALS BASED ON "NO INFORMATION"

WHEN MEMBERS ARE ALREADY DISCHARGED

BENEFIT PLAN(S)

WHAT/HOW/WHERE TO FILE INSTRUCTIONS

TIME FRAMES

ADDITIONAL RIGHTS

Initial Facility Filing

ConnectiCare Acknowledges Receipt

ConnectiCare Determination Notification

Commercial/ Medicare

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

180 calendar days from receipt of written adverse determination.

No acknowledgment is generated.

30 calendar days from receipt for pre-service requests

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

 N/A

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