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Questions?
Just check your provider manual (PDF) for answers about complaints and appeals. Or contact us.
Filing a complaint
Both in-network and out-of-network providers may file verbal or written complaints with us. We can resolve them outside the formal complaints and appeals process. Your complaints could be based on things like:
Policies and procedures
One of our decisions
A disagreement about whether a service, supply or procedure is a covered benefit, is medically necessary or is done in the appropriate setting
Any other issue of concern
Some provider complaints are subject to the member process. In these cases, we transfer them. These include complaints that you may file on behalf of a member.
Filing an appeal
There are three types of appeals:
Provider reconsideration: A request by an in-network or out-of-network provider for review and reconsideration of an adverse benefit determination or an action within 30 calendar days from the date of the remittance advice or decision.
Provider appeal: A request by an in-network or out-of-network provider to appeal actions of the health plan within 30 calendar days from the reconsideration resolution notice.
Administrative (state) appeal: A request by an in-network or out-of-network provider upon completion of the appeal. If the decision isn’t in your favor, you must request the appeal within 30 calendar days of the notice of appeal resolution through Oklahoma Health Care Authority:
Oklahoma Health Care Authority
Legal Docket Clerk Legal Division
P.O. Drawer 18497
Oklahoma City, OK 73154-0497
Phone: 405-522-7217
Fax: 405-530-3444
You can file an appeal if:
We denied reimbursement for a medical procedure or item you provided for a member due to lack of medical necessity or no prior authorization (PA) when it was required
You have a claim that has been denied or paid differently than you expected and wasn’t resolved to your satisfaction through the dispute process
File a complaint or appeal now
You can file a complaint or appeal:
Online
You can file a complaint or appeal in your Provider Portal. Need help with registration? Just contact Availity at 1-800-282-4548. You can get help from 8 AM to 8 PM ET, Monday to Friday.
By email
You can email us your complaint or appeal.
By fax
You can fax your complaint or appeal: 1-833-805-3310.
By phone
You can call us with your complaint or appeal: 1-844-365-4385 (TTY: 711). We’re here for you 8 AM to 5 PM, Monday to Friday.
By mail
You can send your complaint or appeal to:
Aetna Better Health® of Oklahoma
PO Box 81040
5801 Postal Road
Cleveland, OH 44181
Reviews of complaints and appeals
Clinical reviews of complaints and appeals are completed by health professionals who:
Hold an active, unrestricted license to practice medicine or in a health profession
Are board certified (if applicable)
Are in the same profession or in a similar specialty as normally manages the condition, procedure or treatment concerned in the case
Are neither the same reviewer that made the original decision nor someone who reports to that person
Member grievances and appeals overview
When members ask, we help them complete grievance and appeal forms and take other steps.