Appeals must be received in writing, within 120 calendar days of the claim remittance. Submit appeals to:
Attn: Appeals and Grievances Department
Peoples Health
3838 N. Causeway Blvd., Ste. 2500
Metairie, LA 70002
Fax: 504-849-6959
Upon receipt of an appeal, we gather the appropriate documentation, including any additional information available, and perform a complete investigation of the substance of the appeal, including any aspects of clinical care involved. The plan must either uphold or overturn the original decision. The decision must be made by someone other than, and not a subordinate of, the person who made the original determination.
Specifically, medical necessity appeals are reviewed by our medical directors. These appeals may also be sent to an external review organization for same or similar specialty case review and recommendation.
An appeal request submitted without appropriate documentation may be reviewed and classified as an inquiry or claim adjustment request. Please note, inquiries and claim adjustment requests are not subject to the appeals process.
Claim appeals are processed as timely as possible, but no later than 60 calendar days of receipt of the appeal.