NHP has a formalized process for handling provider claim inquiries and claim appeals. Following are the details of when and how to utilize the claim inquiry process.
| What: | A request either verbally or in writing, to request a review of a particular claim, or a further explanation regarding the disposition of a claim. |
| How: | Contact Customer Service at 305-715-2500 or (800) 354-0222 (outside of Miami-Dade) or complete and mail the request for claim review form. (Documentation sent to the plan should include the corresponding form or must clearly explain the nature of the review request. |
| Who: | The provider or the office staff of the provider may request a claim inquiry. |
| Where: | The request for claim review form can be mailed to Claims, Attention Claims Inquiry, PO Box 025680, Miami, FL. 33102-5680. |
NHP will respond back to you in writing on all claim inquiries that do not result in the re-adjudication of the claim. You must file a claim inquiry BEFORE you file a claim appeal.
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| If you would like more information on NHP's formalized process for handling provider claim inquiries and claim appeals, please contact us. | |
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