Grievance and appeal update
We’d like to remind you of the criteria for submitting an expedited appeal/grievance as well as the process to begin a standard or expedited appeal/grievance.
As outlined in your Provider Manual, expedited appeals/grievances must meet certain criteria. An expedited appeal is available if services have not been provided and the timeframe of a standard appeal review could:
- seriously jeopardize the covered individual’s life or health;
- jeopardize the covered individual’s ability to regain maximum function; or if
- in the opinion of a health care professional with knowledge of the member’s medical condition, subject the covered individual to severe pain that cannot be adequately managed without the health care service or treatment being requested.
We will respond to qualifying expedited appeals within 72 hours of receiving the request. Please note that second level appeals for Maine members cannot be expedited.
Expedited appeals/grievances should not be mailed. Please fax your request with a letter of intent and supporting documentation to 855-321-3641.
Please note: For administrative services only (ASO) members, call the service telephone number listed on the member’s identification card to inquire how to begin an expedited appeal/grievance, or see how to request the appeal/grievance via fax below. If you would like to begin an expedited request please be sure the request meets the expedited criteria.
If your situation does not meet the expedited process and you would like to begin a standard appeal/grievance, mail the request to:
Anthem Blue Cross and Blue Shield
PO Box 218
North Haven CT 06473-0218
If you have questions, please refer to your Provider Manual which can be found on anthem.com.
June 2018 Maine newsletter