Appeals and Administrative Error Letters

  • Newborns Removed due to no SSN: An appeal is not needed 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.
  • 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.
  • Higher Ed/Local Ed/Local Gov: Employee was never hired in Edison when first eligible: BA does not need an administrative error letter for this reason. The ABC should use a hire date of 8/1/2016 or greater (because the hire date has to be after the go-live date of eForms).
  • 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.
Have more questions? Submit a request