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Provider reconsideration, appeal and grievance instructions

Aetna Better Health of Illinois 3200 Highland Avenue, F648 Downers Grove, IL 605151 Proprietary Provider reconsideration , appeal and Complaint/ grievance InstructionsProvider submissions will be reviewed and processed according to the definitions in this document, including but not limited to Resubmissions (Corrected Claims and Reconsiderations), Retroactive Authorization Requests, Appeals, Complaints and Grievances. Provider claim reconsiderations and retrospective authorization reviews do not include pre-service disputes that were denied due to not meeting medical necessity. Pre-service denials are processed as member appeals and are subject to member policies and to request each option Options Defined on the following pages Provider Submission Timeframe Resubmission Corrected claim , see page 1-2 Within 180 days of the date of service Resubmission reconsideration , see page 2-3 Within 90 days of original denial Retroactive Authorization Request (Post Service), see page 3-4 Must be received within 30 days of the date of service.

Mar 15, 2022 · • Submit a claim form marked “RECONSIDERATION” at the top with the completed Provider Dispute and Resubmission form found on the last page. • Include additional information required to reconsider the claim single sided. • Refer to the provider manual for provider filing timeframes. Submit reconsiderations to:

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  Form, Claim form, Claim, Single, Reconsideration, Claim single

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