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63 11/2005
BCBSGa
Attn: Provider Appeals
P.O. Box 9907
Columbus, GA 31908
A complaint decision will be sent to the provider in writing within 30 calendar days of
receipt.
First Level Appeal
For an appeal request to be considered, the provider must include documentation
about extenuating circumstances or new information. To file an appeal, the
practitioner will:
• Submit a formal written request for an appeal.
• Include any substantiating documentation that was not previously
reviewed.
• Send the document either by fax or mail as outlined above.
When all information is received from the provider, the Practitioner and Provider
Rights Committee will complete its deliberations and notify the provider of the
decision within 30 calendar days. If applicable, the resolution letter will include
instructions to initiate a second level appeal in the event the provider remains
dissatisfied.
Second Level Appeal
The practitioner or provider will:
• Submit a formal written request for a second level appeal
• Include any substantiating documentation that was not previously
reviewed
• Send the document either by fax or mail as outlined above.
Within 30 calendar days of receiving the provider’s written account, the Second Level
Appeals Committee will complete its deliberations and notify the provider in writing
of its decision. The decision of the Second Level Appeals Committee is final and
binding for all parties.