When can you requests an external independent review?
- If you disagree with the decision made on an appeal, you can request an external review within 30 calendar days of the date on the decision notice.
- External review is not available for appeals related to services received through the Elderly Waiver; Persons with Disabilities Waiver; Traumatic Brain Injury Waiver; HIV/Aids Waiver; or the Home Services Program.
What is an external review?
- An external review is a review by a board-certified provider outside of BCCHP with the same or like specialty as the treating provider. The external provider must be currently practicing, have no financial interest in the decision and must not know the identity of the member during the review.
How to request an external review:
- To request an External Review in writing, send a letter to the address below. You can only ask one time for an external review about a specific action. Your letter must ask for an external review of that action.
Blue Cross Community Health Plans
Attn: Grievance and Appeals Dept.
PO Box 660717
Dallas, TX 75266
Expedited Fax: 1-800-338-2227
When will you get a response to a request?
- Once we receive your request, we will make sure it meets the qualifications for external review. We have five business days to determine this. We will send you a letter letting you know if your request meets the requirements and the name and contact information for the external reviewer.
- You will have five business days to send any additional information about your request to the external reviewer.
- The external reviewer will make a decision about your request within five business days after receiving all the necessary information.
- For an expedited external review, we will send the necessary information to the external reviewer so they can begin their review. Within two business days of receiving all the necessary information, they will let the member or their representative know the outcome of their review. They will also follow up with a letter to the member or their representative within 48 hours of the decision.
Additional Appeal Rights
- For information on additional appeal rights contact BCCHP Customer Service Department at 877-860-2837
Forms for Appeals