8.1.                                Provider Complaint, Grievance, and Appeal Process

MHP supports our providers’ right to grieve or appeal any adverse decisions or coverage issues made by MHP in a timely, fair, and consistent manner. MHP manages these processes as follows:

Provider Contact Center: 800-596-4315.  

This department processes claim payment issues that involve fee schedules and contractual issues.  The representatives are responsible for correcting claim payment errors and researching benefit plans.

Corporate Appeals Department: 800-830-1918, extension 2394.

The Corporate Appeals Department manages provider appeals that involve medical necessity decision-making and prior authorization issues. To facilitate timely decision-making, medical records should be included with the appeal letter. You will receive written communication about the appeal decision.