NY Manual
SHP Manual

New York Provider Manual
15.14 Member Complaints – Medicaid, FHPlus | 15.16 Appealing the Grievance – Commercial, CHPlus

15.15 Standard Appeals – Commercial, CHPlus

A CHPlus member or a member’s designee shall have no more than forty-five (45) days from the date the adverse determination notice is received to file a standard appeal. Healthfirst will accept an oral or written standard appeal. An oral appeal can be filed by calling our toll-free telephone Member Services number, Monday through Friday, between 8am and 8pm.

We will send a notice that the appeal has been received for review within fifteen (15) business days of our receiving the request. The appeal will then be investigated and a decision made within thirty (30) calendar days.

Once we make a decision, the member or member’s designee, as appropriate, will be notified within two (2) business days of our reaching a decision. This notice will include the reasons (and any related medical information) for our decision and further appeal rights.

Healthfirst commercial members have 180 calendar days from the date the adverse determination notice is received to file a standard appeal. 

Healthfirst will provide written acknowledgment of the member’s appeal within fifteen (15) calendar days of receipt of the appeal request.

Written notice of the appeal determination will be provided to the member or member’s designee, as appropriate, and the provider within two (2) business days of our reaching a decision​.