First Level Appeal. If You are dissatisfied that We denied Benefits, You can ask Us to review Your case. You or Your authorized representative must first write to Us within 180 days after We denied Benefits. If We receive Your request after 180 days, We will not consider it. Write to: Blue Cross and Blue Shield of Louisiana Appeals and Grievance Unit P. O. Box 98045 Baton Rouge, LA 70898-9045 If You have questions or need help writing the Appeal, call: Customer Service Department 0-000-000-0000 or 0-000-000-0000 When We receive Your request for a first-level Appeal, We will investigate Your concerns. Within 30 working days after We receive Your request for a first-level Appeal, We will write to You, unless You, Your authorized representative, and We agree that We have more time to respond. ◼ If We change Our original decision at this level, We will process Your Claim and will write to You and all appropriate providers. ◼ If We do not change Our original decision, We will write to You and all appropriate providers to explain that You can ask for a second-level Appeal.
First Level Appeal. An employee may file a written appeal of the Principal Human Resources Representative’s finding to the First Level Appeal. Appeals must be filed in writing with the Chief Human Resources Officer within ten (10) working days of the receipt of the Principal’s recommended reclassification determination. The First Level Appeal is conducted by the Principal.
First Level Appeal. (a) An employee must submit a written intent to appeal to the Disability Management Provider within seven (7) calendar days of the original decision having been communicated to the employee in writing.
First Level Appeal. A first level appeal will be reviewed by the Director of Claims. If the determination reached is unacceptable a second level appeal will be initiated.
First Level Appeal. If the dispute or claim is still not resolved to Contractor’s satisfaction at the Formal Claims Appeal level, Contractor may file a written First Level Appeal, within thirty (30) calendar days following the determination from the Formal Claims Appeal level, with the Healthcare Invoicing Section Associate Director at the following address: First Level Appeal California Correctional Health Care Services Healthcare Invoicing Section Attn: Associate Director P. O. Box 588500, Building D Elk Grove, CA 95758 The Healthcare Invoicing Section Associate Director or designee shall issue a written decision in response to Contractor’s First Level Appeal within fifteen (15) calendar days of receipt of the First Level Appeal. The written decision shall either:
First Level Appeal. For disagreements regarding claim payments, or claim denials by HIS for a claim billed under the Agreement, Contractor may file a First Level Appeal within thirty (30) calendar days following the determination from the Payment Inquiry, with the HIS Appeals Team at the following address: California Correctional Health Care Services Healthcare Invoicing Section Attn: Appeals Team PO Box 588500, Building D Elk Grove, CA 95758 The First Level Appeal shall be sent with a detailed reason(s) and justification of dispute, a copy of the claim originally submitted, patient’s name, CDCR number, date(s) of service, amount paid, Provider’s contact name, phone number/email address, legal authority or other basis for position, and any other documentation in support of the Appeal, and remedy sought. The Appeals Team shall review the First Level Appeal for payment or non-payment. If the review determines that CCHCS owes additional compensation, the Appeals Team shall process the reimbursement. If the review determines that CCHCS owes no additional compensation, the Appeals Team shall issue a written decision to Contractor explaining the payment denial within thirty (30) calendar days. If the review determines that Contractor was overpaid, the HIS Refunds Team will issue a refund recovery letter to Contractor within sixty (60) calendar days. CCHCS, in its sole discretion, may recover overpayments in the manner set forth in Section 63, Overpayments and Offsets of this exhibit.
First Level Appeal. If the claim is still not resolved to Contractor’s satisfaction at the Formal Claims Appeal level, Contractor may file, within thirty (30) calendar days after the date of the Claims Appeal response, a written First Level Appeal with the Associate Director, CCHCS, Healthcare Invoicing Branch, at the following address: Attn: First Level Appeal Associate Director Healthcare Invoicing Branch (HIB) California Correctional Health Care Services P. O. Box 588500 Elk Grove, CA 95758 The Associate Director, CCHCS, HIB or designee shall issue a written decision to Contractor within fifteen (15) calendar days from receipt of Contractor’s First Level Appeal. The written decision shall either: (1) document the dispute settlement and what, if any, conditions were reached; or (2) document the reason(s) the dispute could not be resolved and provide notification to Contractor of its option to file a Second Level Appeal within thirty (30) calendar days of the date of the written decision.
