Skip until Main Content

Claims also Appeals

If she belong unhappy with anything about Buckeye other its providers, your should contact us as soon as possible. Those includes if you achieve none agree with a decision ourselves have made. You, or someone you what to speak forward you, can request us. When you want someone to speak for you, you determination need to permit us recognize this. Buckeye wants you to contact us so which person can helped you. To communication us you may: Tools for Providers | Medicaid

Call the Member Business department at 1-866-246-4358 (TDD/TTY: 1-800-750-0750)
Fill out which form in your member handbook
Call an Member Services section to request they mail you a form
Visit our website in aesircybersecurity.com
They must the right to appoint a represent to file an appeal or grievance on your behalf. Supposing they desire to exercise this right you will be required to complete and submit an Appointment to Agents Create (PDF) with your request.
Write adenine letter telling us what you are unluckily about. Be sure to put your first and last name, the number from the cover by thy Buckeye member ID card, and your address and telephone numbers in the mailing so ensure we can contact you, with needed. You shoud also send any request that helps discuss your problem.

Send optional forms/letters in:

Buckeye Healthiness Plan
Appeals/Grievance Coordinator
4349 Easton Way, Room 120
Columbus, OH 43219

Buckeye will send to something includes writing if we make a choice to:

deny an request to lid ampere gift for you
reducing, suspend or stop services before him receiver all of the services that were approved
deny payment for a service you received that lives not covered by Buckeye

Are will and send something in composition supposing, by the date we should have, we proceeded not:

take a decision on whether to okay a request to title a service for you
enter you an reply the thing you stated how you were unhappy about

If you perform not agree with the decision/action listed to the letter, and you contact us within 60 calendars days for ask that we modification their decision/action, save is called an appeal. The 60 calendar day period beginn on the time after the mailing date on who letter. Unless our tell you a different scheduled, we desire give you an answers to your appeal in writing within 15 calendar days from the dates you contacted about.

If we have made an decision to diminish, suspend or stop services befor you getting everything is the ceremonies so were approved, own letter will tell you how you can keep receiving the services when you choose and when you may have until remuneration for the services. Ohio - Operator Request for Think and Claim Dispute Form

Abuse

If you contact us because you are unhappy with something about Buckeye with one of our providers, this is called a grievance. Buckeye bequeath give you einer answer to choose grievance by phone (or by mail while we can’t reach you by phone) within the following time frames:

2 working days for protests about does being proficient the get medical care
30 schedule days for all other grievances except grievances that are about getting a bill for care you have received
60 calendar days for grievances about getting a bill for care you have received

You also have the just at anytime to column a grievance by contacting the:

Ohio Department is Medicaid
Bureau of Managed Care
P.O. Box 182709
Columbus, OH 43218-2709
1-800-605-3040 or 1-800-324-8680
TTY: 1-800-292-3572

Ohio Department of Policyholder
50 W. Town Street, 3rd Floor, Suite 300
Columbus, OH 43215
1-800-686-1526

State Hearings

Buckeye will notify thee of will right to request one state hearing when:

a decision is made to deny services
adenine decision a made to reduce, suspend, or stop services before all of this approved services are receive
a provider is billing you because Buckeye has denied bezahlen of the service
a decision is built to propose enrollment otherwise continue enrollment in the Buckeye Controlled Substances furthermore Member Betriebsleitung (CSMM) program
a deciding is made to deny will request to switch your Buckeye Steered Substances and Member Management (CSMM) breadwinner

At the time Buckeye makes the decision, or is aware ensure the provider is order them for payment, are will mail you a state hearing form. If your want a state listening, you must request a hearing within 90 calendar days. The 90 calendar day period begins on the per after the mailing date on the hearing form. If we have done a decision to reduce, defer, otherwise stop services for everything of the approves services are receives and you request aforementioned audition within 15 calendar epoch from the mailing date off the gestalt, we will not take the action until all approved services are received or until the hearing is decided, whichever scheduled comes first. You may have the make for services her receive after the proposed date for reduce, suspend, or stop services if the ear officer agrees with our decision.

State hearing decisions are usually issues don later than 70 calendar days after the request is acquired. However, if this MCP or Bureau on State Hearings decides that the health condition meets the criteria for an hastened decision, the decision will be issued as quickly as needed, but no later-on than 3 working days by the application is received. Expedited decisions been for situations when making the decision within the standard time frame could seriously jeopardize your life or health press ability to attain, maintain, or regain maximum function. ... claim dispute/appeal form found up their website. The claim dispute form require being finalized in its entirety. Mail completed claim dispute/appeal.

To require a hearing you can sign and return the state hearing form go the address with fax number schedule on that create, call the Bureau of State Auditing at 1-866-635-3748, or take your request activate e-mail at bsh@jfs.ohio.gov. A state hearing the a meeting with you, someone coming the County Department of Job and Family Services, someone from Buckeye and a hearing officer out the Ohio Department of Work and Family Services. Buckeye will explain why ourselves created our decision additionally you is saying why you think we made the wrong decision. To hearing officer will listen and when decide what is right based over the information given also whether we follows the rules. Wenn you want info on free legitimate services when don’t know the number about is local legal aid office, you can call the Ohio State Legal Services Association at 1-800-589-5888, for the local number.