1 . Practitioners , whose credentials have not been accepted because of the following reasons , may access the appeals process :
• Quality issues
• Practice competence issues
• Prior disciplinary actions
• Utilization issues
• Other practice related issues
2 . A practitioner whose application has not been accepted due to the following reasons is NOT eligible to access the appeals process :
• Network adequacy pertaining to that practitioner ' s particular specialty , or
• Failure to comply with HTH ' s request for additional information
3 . The Notice of Denial will include the reason for denial as well as the practitioner ' s right to appeal to the Level I or Level II stage .
4 . The practitioner has 30 days from receipt of the denial letter to request engaging the appeal process , for both the Level I and the Level II appeals .
LEVEL I APPEAL
1 . The Level I Appeal Process is only available to existing , contracting practitioners / organizational facility providers on the Hometown Health network . Initial , non-contracted , practitioners / organizational facility providers who have been reviewed and denied by the MAC may reapply in three years . The practitioners / organizational facility providers may only reapply twice for reconsideration before the application will no longer be considered further .
The purpose of the Level I appeal is to provider information the MAC may not have seen or to correct information the MAC used in making the recommendation for denial .
The Appeals Process is initiated with a written request to the Hometown Health Credentialing Specialist by the practitioner to appeal the MAC decision . The request for the appeal must be made within thirty days from receipt of the denial letter .
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2 . The practitioner ' s name will be placed on the agenda of the next MAC meeting immediately after receipt of the written request . The Level I Appeal is hosted by MAC and conducted by a three person panel comprised of selected participating and