Grievances and Appeals

The grievance and appeal process is intended to provide a reasonable opportunity for a full and fair review of an adverse determination. The process varies slightly based on federal and state regulations.

For additional information, please refer to our Participating Provider Manual

  • For Commercial Members - Section 4.12 Utilization Review Appeals and Grievances
  • For Medicare Members - Section 9.5 Member Grievances, Organization Determinations and Appeals
  • For Medicaid Members - Section 10.11 Member Grievance and Utilization Review Appeal Policy and Procedure


GDPR Notification Content