An error was made in the September 2014 edition of Provider Focus pertaining to the timing requirements of the provider appeal process. The article should have stated, “A provider appeal must be filed within 90 days from the date of the claim adjustment/reconsideration request denial.” Please refer to the following revised provider appeal process.
MHP revised its claim adjustment/reconsideration request procedure to include an appeal process for claim adjustment/reconsideration requests that have been denied. Effective August 1, 2014, a provider has the option to file a provider appeal, which is a second review of the claim adjustment/reconsideration request denial.
Key components of the provider appeal process include:
Documentation required for a provider appeal includes: