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Provider Complaints and Claim Disputes

Provider Claim Disputes

A Claim Payment Dispute is defined as a finalized claim in which the provider disagrees with the outcome. All requests for claim payment disputes must be submitted within 180 days (or as required by law or your participation agreement) from the date of the Explanation of Payment (EOP) or Provider Remittance Advice (PRA) utilizing the Provider Dispute Form.

Detailed information on the Provider Claim Dispute process and instructions for filing are included in the Billing Manual.

Provider Complaints

A provider has the right to file a complaint with us regarding Oklahoma Complete Health policies, procedures, or any aspect of Oklahoma Complete Health administrative functions. Complaints are spoken or written expressions of dissatisfaction.

Oklahoma Complete Health wants to resolve provider concerns. We will not hold it against the provider if they file a complaint, or treat a provider differently for doing so.

Detailed information and instructions for filing a complaint are included in the Provider Manual.

 

Last Updated: 05/05/2021