When completing a written request for reconsideration of a completely or partially denied claim please include the completed Hometown Health Reconsideration Form . Indicate the specific reason that you want this claim reprocessed and attach all supporting documentation . The more complete the documentation , the more quickly the reconsideration can be processed .
Hometown Health will respond within sixty ( 60 ) days of receipt of the reconsideration request with either an EOP or an explanation advising that the decision has been upheld and why .
Appeals for untimely filing should include confirmation that Hometown Health received and accepted your claim within the 365 days after the date of service or other supporting documentation if Hometown Health was not sent the claim because of presumed or confirmed other primary insurance coverage for the member .
Dispute Resolution
If you do not agree with the outcome of the provider reconsideration , you may resubmit another reconsideration with additional supporting documentation for review . All claim reconsiderations and disputes must be submitted within 90 days from the date of explanation of payment unless otherwise outlined in the provider agreement .
Disputes arising between the provider and Hometown Health related to performance or interpretation of the Provider Agreement or the Administrative Guidelines will be attempted to be resolved in good faith by non-legal means . Disputes may be brought to the attention of Hometown Health leadership by emailing
HTHProviderRelations @ hometownhealth . com . Please include “ Provider Dispute ” in the subject line .
Non Claim Complaints
For any non-claim related complaints please email
HTHProviderRelations @ hometownhealth . com . Please include “ Non Claim Related Complaint ” in the Subject line . A response will be sent to the provider or third party entity no later than 30 calendar days from receipt of the complaint , or as dictated by the state regulation .
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