Request for Claims Review Determination Time Frame – May 2020
Posted on May 4, 2020
As most know, every provider has a right to request a review of their claims payment if they disagree. Here at Health New England, we allow you to submit a request for review 12 months from the date of service or date of discharge for inpatient services. We do ask for a Request for Claim Review Form and supporting documentation to be mailed to Health New England at One Monarch Place, Suite 1500, Springfield, MA 01144. This form can be found at https://healthnewengland.org/forms under the Providers tab.
Although we do our best to turn these requests around quickly, to thoroughly research and make a determination, it takes approximately 90 business days. This is a change to the time frame we have historically done, but it will ensure the accuracy of our review and reduce the ask for a 2nd review. Please note, we will not take the full 90 business days, if it is not necessary.
For more information on this process, please review the Request for Claim Review Guide on https://healthnewengland.org/forms or call your Provider Relations rep at (800) 842-4464, ext. 5000. You may also email providerrelations@hne.com.
