As a healthcare provider, you may wish to discuss an adverse determination with an HCP clinician. If so, please refer to the instructions outlined in the adverse determination letter sent to your office for next steps.
For Medicare Members
Note that for Medicare products, all calls requested AFTER a decision has been rendered by an HCP Medical Director Reviewer and subsequently communicated to the provider, the provider’s office, or to the member, either verbally or in writing, HCP cannot, by regulatory standards, change a determination decision. You must file a formal appeal following the instructions included in the adverse determination statement that is sent to your office.
For Commercial and Medicaid Products
For Commercial and Medicaid products, you may request a reconsideration within the timeframe specified in the decision notification that is sent to your office.
