The Claim Reconsideration and Dispute process are outlined on pages 6-7 in the Provider Billing Manual, located on our website under Provider Resources. If the Claim Dispute decision is still unfavorable, you have the option to file an escalated appeal letter and include all documentation included in the Reconsideration and Dispute forms. Be sure to include any additional documentation and detailed explanation as to why you disagree with the Reconsideration decision. If you feel you have received an unsatisfactory decision on the Reconsideration Request, then you can file a Claim Dispute Form as a second level appeal. If you disagree with how a claim was adjudicated, you must first file a Reconsideration Request with a detailed description as to why you are disputing the denial as well as any supporting documentation (medical notes, etc.). Initial Claims - Days are calculated from the Date of Service to the date received by NH Healthy Families.Ĭlaims Reconsiderations or Dispute/Appeals - Days are calculated from the date of the Explanation of Payment issued by NH Healthy Families to the date received.Ĭoordination of Benefits - Days are calculated from the date of Explanation of Payment from the primary payers to the date received by NH Healthy Families.Īll claims received outside of the above timeframes will be denied for untimely submissions.
Additional reconsiderations, claim disputes or corrected claims submitted 15 months from the original date of service will not be considered for payment. The timely filing requirements for claim reconsiderations, claim disputes and corrected claims will remain at 180 days from original date of notification of payment or denial, not to exceed 15 months from the original date of service. NH Healthy Families is revising our filing limit from 365 days to 90 days for initial claims with dates of service on or after January 1, 2018. Revised Timely Filing Requirements Effective January 1, 2018
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