Common use of Provider Disputes Clause in Contracts

Provider Disputes. Contractor’s Quality Management (“QM”) department is responsible for resolving Participating Provider disputes. Providers may contact the QM department by mail at [address] or by calling the Participating Provider Dispute Department at [insert number]. Contractor will accepts submitted Participating Provider disputes for claims that were submitted by the Participating Provider within one year of the original decision date. Contractor’s QM department will acknowledge receipt of a provider claim dispute within five (5) working days of receipt and resolve provider disputes within forty-five (45) days of receipt of all reasonably relevant information.