These guidelines do not apply to the submission of an amended claim to a previously processed claim within 180 days from date of service. An amended claim submitted within 180 days is an On Time Corrected Claim, and not a Provider Appeal. Please note on the claim form that it is an On Time Corrected Claim and mail it to: HNE Claims Department, One Monarch Place, Springfield, MA 01144. Faxed On Time Corrected Claims will not be accepted

Provider Appeal Guidelines

• A provider has the right to file a Provider Appeal if they disagree with how HNE processed a claim.
  
  
• Provider Appeals must be submitted within one year from the date of service. An appeal submitted after the one year deadline will be denied.
  
  
• A Provider Appeal must be submitted on the HNE Provider Appeal form, which can be found under Provider Forms on the HNE websites, www.hne.com or www.hnedirect.com, and in the HNE Provider Manual.
  
  
• The control number, the 12 digit number on the HNE Explanation of Payment (EOP), must be listed on the Provider Appeal form.

Please include with your appeal

• The EOP and all supporting documentation, such as operative and office notes, authorizations, invoices, and other information which would be pertinent to the review process, rationale for appeal, and desired resolution.
  
  
• PLEASE NOTE: If you are disputing a denial of a Prior Approval Request Form and the service has not yet been rendered, your appeal will be treated as a Member Appeal and processed in accordance with HNE’s Member Appeal Guidelines.
  

If you have any questions regarding submission of a Provider Appeal or an On Time Corrected Claim, please contact your HNE Provider Relations Representative at:
(413) 787- 4000 ext. 5000 or (800) 842-4464 ext. 5000.