Member Services: 1-844-243-5187 (TTY use 711) Available 8am - 7pm Monday - Friday | Language Assistance

Provider Complaints and Disputes

Providers have the right to file a dispute regarding policies, procedures, including claims/billing disputes, and service authorizations.

Providers may file a complaint by contacting Provider Services at 844-243-5188 or by mail at:

                                                 

      Miami Children’s Health Plan
      5959 NW 7th Street
      Miami, FL 33126
      1-844-243-5187 

 

Type of Appeal

Timing of Appeal

Response Time

Non-Claims Issues

Must be submitted within forty-five (45) calendar days from the date the issue occurred

Providers will be notified within three (3) business days of receipt verbally or in writing that the complaint has been received and the expected date of resolution.

Complaints will be resolved within ninety (90) days of receipt.

Claims Payment Issues

Must be submitted within ninety (90) calendar days of the date of final determination of the

primary payer.

Providers will be notified within three (3) business days of receipt verbally or in writing that the complaint has been received and the expected date of resolution.

Complaints will be resolved within sixty (60) days of receipt of a claim complaint.