Appeals / Grievances
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Medicare defines a grievance as any complaint or dispute, other than one involving an organization determination, that expresses dissatisfaction with the manner in which a Medicare health plan or delegated entity provides health care services, regardless of whether any remedial action can be taken. In addition, grievances may include complaints regarding the timeliness, appropriateness, access to, and/or setting of a provided health service, procedure, or item. Grievance issues may also include complaints that a covered health service procedure or item during a course of treatment did not meet accepted standards for delivery of health care. Any member, or their representative, may file the grievance, either orally, by calling the Plan's Grievance and Appeals department, or in writing to the department.
Appeals
The Government Program Compliance Department is responsible for directing and administering AAHP's compliance and associated programs. The department provides education and training on compliance program, resources and reporting mechanisms, including information about federal and state rules and regulations, such as the False Claims Act, Deficit Reduction Act and the Centers for Medicaid and Medicare Service program requirements. In addition, the department conducts routine monitoring and auditing activities to verify compliance with regulatory, legal and contractual requirements and identify best practices and areas in need of process improvements.
This department also manages the processing of member appeals and provider disputes (collectively referred to as "Appeals"). All appeals submitted to the health plan are investigated and resolved using applicable statutory, regulatory, contractual and policy provisions.
If you have questions, or would like to submit an appeal, please contact us at (602) 824-3735 or 1-800-747-7997 extension 3735. You may also submit an appeal by fax to 602-674-6673 or by writing to:
Member Appeals
Abrazo Advantage Health Plan
7878 North 16th Street, Suite 105
Phoenix, AZ 85020
OR
You may complete the online grievance form to file a grievance electronically. We will contact you within 2 business days.
Provider Disputes
Abrazo Advantage Health Plan
7878 North 16th Street, Suite 105
Phoenix, AZ 85020
To review Important Information About Your Appeal Rights, please click here.