The Holman Group - Provider Manual

Dispute Resolution Mechanism for Non-Clinical Issues

If a provider has a dispute regarding non-clinical issues (e.g. claims, contractual, credentialing, termination), s/he may submit the issue by e-mail, U.S. Postal Service, or fax to the Director of Provider Relations in the Provider Relations Department at 9451 Corbin Avenue, Suite 100, Northridge, CA 91324. The fax number is (818) 346-3753 or e-mail the Provider Relations Department by using the contact list through www.HolmanGroup.com. If the Provider is unable to submit a dispute in writing, the Director of Provider Relations may assist; call (800)321-2843.

Disputes must contain at minimum: Provider's name, provider's identification number, provider's contact information and: If regarding claims or billing; a clear identification of the disputed item, the date of service and a clear explanation of the basis upon which the provider is disputing. If regarding other issues; a clear explanation of the issue and the provider's position on such issue. If the dispute involves a member, it must also include the name and identification number(s) of the member(s). If submitting similar multiple disputes in a bundle, the dispute must also include the following:

• Sort provider dispute by similar issues
• Provide cover sheet for each batch
• Number each cover sheet
• Provide a cover letter for the entire submission describing each dispute submitted.

Disputes regarding a claim must be submitted within 365 days from action that led to dispute. The Holman Group will acknowledge receipt of the disputes within two (2) working days if it is filed electronically and within fifteen (15) working days if the dispute is paper filed. A written determination will be rendered within forty-five (45) working days of receipt of the dispute.

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