Can I appeal denials of prior authorization or post procedure authorization requests?
Provider appeals are available for services where prior authorization has been requested or which have already been completed and which were denied as a result of a request for post procedure authorization. CTDHP/BeneCare has established an internal appeals mechanism for providers. All appeals must be submitted in writing to the above address. If a provider is not satisfied with the final determination upon exhaustion of the CTDHP/BeneCare internal appeals protocols, providers may avail themselves of an independent third party review established by the Department of Social Services. Clients may also appeal services which have not yet been rendered and which are reduced, suspended or denied as a result of a request for prior authorization. Clients will be notified of their appeal rights at the same time that prior authorization status notifications are issued to providers.
