Member Complaint - First Level Process Tables

Table 21-2, First Level Member Complaint - Expedited

Commercial and Medicare Plans

BENEFIT PLAN(S)

WHAT/HOW/WHERE TO FILE

TIME FRAMES

ADDITIONAL RIGHTS

Initial 
Member
Filing

ConnectiCare Acknowledges Receipt

ConnectiCare Determination Notification

ConnectiCare/ ConnectiCare of Massachusetts

Write to:

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

Telephone:
800-251-7722

60 business days from event

N/A

Verbal response within 24 hours for Medicare and 48 hours for commercial of receipt of necessary 
information.

Written notice sent within three business days of determination

N/A

TABLE 21-3, FIRST LEVEL MEMBER COMPLAINT - STANDARD

Commercial and Medicare Plans

BENEFIT PLAN(S)

WHAT/HOW/WHERE TO FILE

TIME FRAMES

ADDITIONAL RIGHTS

Initial 
Member
Filing

ConnectiCare Acknowledges Receipt

ConnectiCare Determination Notification

ConnectiCare

Write to:

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

Telephone:
800-251-7722

60 business days from event.

15 business days from the receipt of the request for commercial and 15 calendar days from the receipt of the request for Medicare.

30 calendar days (with possible 14 day extension) for Medicare and 45 calendar days for commercial from receipt of all necessary information.

N/A

ConnectiCare of Massachusetts

Write to:

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

Telephone:
800-251-7722

60 calendar days from event.

15 business days from the receipt of the request for commercial and 15 calendar days from the receipt of the request for Medicare.

30 calendar days (with possible 14 day extension for Medicare) from receipt of all necessary 
information.