Table 21-1, Practitioner Complaint/Grievance Procedure

COMMERCIAL AND MEDICARE PLANS

BENEFIT PLAN(S)

WHAT/HOW/WHERE TO FILE HARD COPY*

TIME FRAMES**

ADDITIONAL RIGHTS

Initial 
Practitioner Filing

ConnectiCare Acknowledges Receipt

ConnectiCare Determination Notification

COMMERCIAL/MEDICARE

Unless otherwise directed in the denial letter or Explanation of Payment (EOP), write to:

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

Telephone:
800-251-7722

60 calendar days from event.

N/A

Complaint: 30 calendar days from receipt of request.

Grievance: 30 calendar days for Medicare and 90 calendar days for commercial from receipt of request.

Decision is final.