Monday, September 27, 2010

Appeals Submission Process - Prestige insurance

1. A member or provider (acting on behalf of the member)
must submit a request either verbally or in writing within
thirty (30) calendar days of the date of the notice of action
to Prestige Health Choice.

2. If Prestige Health Choice did not issue a written notice of
action, then the member or provider (acting on behalf of
the member) may file an appeal within one (1) year of the
date of the action.

3. If filed verbally, the request must then be followed up with a
written, signed appeal submitted to Prestige Health Choice
within 10 working days.

4. For verbal filings, the time frames for resolution begin on
the date the verbal filing was received by Prestige Health

5. If the member wishes to use a representative (including the
physician), then he/she must complete an Appointment of
Representative statement. This form is located in the Forms
section of this manual.

6. The member and the person who will be representing the
member must sign the statement.

Prestige Health Choice will make a determination on an appeal
within the following time frames:

• Expedited Request: 72 hours
• Standard Request: 30 calendar days
• Retrospective Request: 45 calendar days

Appeals must be submitted in writing to:
Prestige Health Choice
Grievance and Appeal Department
P.O. Box 19709
Charlotte, North Carolina 28219-9709
Or by Toll-free Telephone to:
Or by Toll-free Fax to:

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