Appeals and Administrative Error Letters

o   Appeals, Administrative Error Letters and More:

o   Newborns Removed due to no SSN: An appeal will no longer be submitted if the child was removed due to not submitting the SSN within 60 days. The ABC should provide the new SSN either through a Zendesk ticket or via a Corrections & Clarification form. 

 

o   Pre-paid dental cancel requests: This is not an appealable issue. ABCs should submit request to cancel on the Insurance Cancel Request form. BA will verify if we have any participating dentists within a 40 mile radius of the member’s home address.  If we do and they are accepting new patients, then the request to cancel will be denied.

 

o   Higher Ed/Local Ed/Local Gov: Employee was never hired in Edison when first eligible: BA no longer needs an administrative error letter for this reason  The ABC will need to use a hire date of 8/1/16 or greater (because the hire date has to be after the go-live date of Eforms).
 

o   Higher Ed/Local Ed/Local Gov: Member hired with the incorrect hire date: The ABC can either submit the correct hire date via a Zendesk ticket or submit a Corrections & Clarification form.  BA will make the correction in Edison.

 

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