R21-1-213. Provider Claim Disputes and Appeals

A. Provider claim disputes and Member Appeals for a DCS CHP Member who is Medicaid eligible follow the rules prescribed in 9 A.A.C. 34. B. Provider claim disputes and Member Appeals for a DCS CHP Member who is not Medicaid eligible follow: 1. A.A.C. R9-34-203. Computation of Time, 2. A.A.C. R9-34-208. Who May File, 3. A.A.C. R9-34-209. Enrollee Time-frame for Filing an Appeal or Grievance with the Contractor, 4. A.A.C. R9-34-210. Contractor General Requirements for Grievance or Appeal Process, 5. A.A.C. R9-34-213. Contractor Time-frame for Standard Resolution of an Appeal, 6. A.A.C. R9-34-214. Contractor Process for an Expedited Resolution of an Appeal, 7. A.A.C. R9-34-215. Contractor Time-frame for an Expedited Appeal Resolution, 8. A.A.C. R9-34-225. Reversed Appeal Resolutions, 9. A.A.C. R9-34-403. Computation of Time, 10. A.A.C. R9-34-404. Content of Claim Dispute, and 11. A.A.C. R9-34-405. Filing a Claim Dispute for a Claim Involving a Member Enrolled with a Contractor. C. Provider claim disputes and Member Appeals hearing procedures for a DCS CHP Member who is not Medicaid eligible follow the rules prescribed in 21 A.A.C. 1, Article 3.