Grievances and Appeals

Date: 12/15/16

Heritage Health (Medicaid):

Grievance resolution time frame

Grievance Resolution will occur as expeditiously as the member’s health condition requires. Grievances will be resolved by the Grievance and Appeal Coordinator, in coordination with other Nebraska Total Care staff as needed. Many grievances can be resolved at the customer service level to the satisfaction of the member, representative or provider filing the grievance. Standard grievance resolution and notification will occur within 90 days of receipt of the grievance. 

Appeals resolution time frames

Appeals must be requested with 60 days of the dated on the Adverse Benefit Determination letter.  Standard appeals will be resolved, with notification, within 30 days. A request can be made for an expedited appeal if there is an urgent medical need. Expedited appeals are resolved, with notification, within 72 hours.