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Sunday, June 6, 2010

Timeframe for BCBS claim denial appeal and Grievances

BCBSAZ timeframes to file Appeals and Grievances

Level 1 Claim Appeal: Should be filed within 2 years from initial denial. (FEP Appeals must be filed within 1 year)
Level 2 Claim Appeal: Should be filed within 60 days of Level 1 determination.
Level 3 Claim Appeal: Should be filed within 30 days of Level 1 determination. (FEP is excluded from Level 3 appeals)
Level 1 Grievance: Should be filed within 1 year of claim processed date.
Level 2 Grievance: Should be filed within 60 days of the Level 1 determination.

Timeframes for FEP, BlueCard and CHS accounts may vary.

Important reminders: Please include the member name, member ID, claim #, provider name, provider #, contact person and phone number on all appeals. Send the appeal to the appropriate address and mail stop as indicated on the previous page; otherwise, delays in processing may occur.

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