Provider Manual - Carelon-PA


Ang administratibong reklamo ay anumang reklamong nauugnay sa isang provider, isang entity ng gobyerno, isang institusyon, o isang Managed Care Organization na ihaharap ng sinuman maliban sa isang miyembro, sa nakasulat man o pasalitang anyo. Ang isang Administrative Complaint ay hindi isang kahilingan para sa isang retro-authorization ng serbisyo o isang muling pagpapasiya ng pagbabayad. Ang isang Administrative Complaint ay hindi maaaring simulan ng isang miyembro.

Behavioral health administrative complaints may be initiated either by telephone on the toll-free provider line at 877-615-8503 or in writing addressed to:

Carelon Health of Pennsylvania
PO Box 1840
Cranberry Township, PA 16066-1840
Attention Reklamo Imbestigador


Behavioral health administrative complaints may also be faxed to the Quality Management Department (855-287-8491).

Carelon-PA will document and work to resolve all administrative complaints within thirty (30) calendar days of receipt. If a complaint cannot be handled at the first point of contact, it will be assigned to a Complaint Investigator to resolve the complaint in an expedient manner. A letter outlining the resolution of the initial complaint will be sent to the complainant when the resolution of the complaint is accomplished, or within five (5) business days after the initial thirty (30) calendar days allocated for the complaint resolution, whichever comes first.