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How Do I Appeal an Adverse Decision?

If you have any questions regarding an adverse determination, you may request reconsideration and discuss the determination with a CareCore physician reviewer. Should you disagree with this decision, you have the right to appeal utilization review determinations. If you wish to appeal this decision, contact a CCN representative by telephone at 1 866 803-8002 or send a letter of appeal within 180 business days of receipt of the letter. Please include the patient’s name, member identification number, and a written explanation of why you believe that this case should be certified. Supply any pertinent clinical information, peer review articles, circumstances and any comments that you wish to present for consideration that may support your appeal to the address or fax number below:

CareCore National, LLC
Attention: Appeals
169 Myers Corners Road
Mail Stop 600
Wappingers Falls, NY 12590

Fax Number: 845 298-1490

You will be notified of the decision in writing within 30 calendar days.

An expedited appeal is available when a delay in decision-making might seriously jeopardize the life or health of the patient. If you wish to arrange for immediate review or if you have any questions, contact the CareCore Clinical Certification Department at 1 866 803-8002. If your case meets the criteria for an expedited appeal, CCN will decide within 72 hours after receipt of the request.

Last Updated November 2007