Partners maintains a formal process, consistent with its written agreements, to address alleged violations of the agreement by participating providers.
The Dispute Resolution Process is available to any participating provider who wishes to initiate it. However, certain types of disputes are subject to the process:
- Disputes concerning professional competence or conduct that results in a change in provider status
- Disputes involving administrative matters
To learn more about this process, please review the Participating Provider Disputes Policy and Procedure.
Providers wishing to initiate a dispute may do so by completing the Provider Dispute Resolution Form. Providers should be aware that:
- The request (submission of the Provider Dispute Resolution Form) must occur no later than 21 calendar days from the receipt of the Local Management Entity/Managed Care Organization’s (LME/MCO) decision resulting in the request.
- If a provider fails to meet the timeframe above, the decision of the LME/MCO becomes final and the provider may not utilize the Dispute Process.