![]() ![]() You will receive directions from the Quality Improvement Organization (QIO) regarding additional appeal options. The Quality Improvement Organization will respond to you as soon as possible, but no later than 14 days after receiving your request for a second review. You may ask for this review immediately, but must ask within 60 days after the day the Quality Improvement Organization said no to your Level 1 Appeal. ![]() Within 48 hours the reviewers will tell you their decision. When you'll hear back from the Quality Improvement Organization (QIO) A claim reconsideration request is not an appeal and does not alter or toll the deadline for. Meritain Health is the benefits administrator for. When you’re caring for a Meritain Health member, we’re glad to work with you to ensure they receive the very best. We do our best to streamline our processes so you can focus on tending to patients. Visit our other websites for Medicaid and Medicare Advantage. What is the time limit for submitting claims to Medical Assistance The original claim must be received by the department within a maximum of 180 days after. Meritain Health works closely with provider networks, large and small, across the nation. Medicare Advantage or Medicaid call 1-86. (Please refer to above directions regarding filing an expedited appeal) Difference in Coordination of Benefits (COB) information. Use our online Provider Portal or call 1-80. If you miss the deadline for contacting the Quality Improvement Organization about your appeal, you can make your appeal directly to us instead. You must contact the Quality Improvement Organization to start your appeal no later than noon of the day after you receive the written notice telling you when we will stop covering your care. You can ask to change this decision so you're able to continue coverage. Medicaid Managed Care and Child Health Plus. When your coverage for that care ends, we'll stop paying our share of the cost for your care. Healthfirst Customer Service Telephone Number Health First Phone Number for Members. You’ll receive a "Notice of Medicare Non-Coverage (NOMNC)" in writing at least 2 days before we decide it’s time to stop covering your care. (Usually, this means you’re getting treatment for an illness or accident, or you're recovering from a major operation.) Rehabilitation care as an outpatient at a Medicare-approved Comprehensive Outpatient Rehabilitation Facility (CORF).Skilled nursing care as a patient in a skilled nursing facility.Employee must file an appeal with Aetna within. You have the right to keep getting your covered services for as long as the care is needed to diagnose and treat your illness or injury if you’re getting: State of Delaware Health Maintenance Organization (HMO) 1-877-54-AETNA. ![]()
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