Provider Complaints

You may file an informal complaint about AmeriHealth Caritas Delaware's policies or procedures, or any aspects of the plan's administrative functions, including proposed actions, claims- and billing-related issues, and service authorizations.

What is a complaint?

A complaint is a request from a health care provider to change a decision made by AmeriHealth Caritas Delaware related to claim payment; policy, procedure, or administrative functions; or denial for services already provided. A provider complaint is not a pre-service appeal of a denied or reduced authorization for services or an administrative complaint.

Examples of complaints:

Examples include, but are not limited to:

• Credentialing concerns, such as timeliness, allegation of a discriminatory practice, or policy.
• Claim-related issues, including inaccurate payment, claim denials, and post-service authorization denials.
• Service issues with AmeriHealth Caritas Delaware, including failure by the plan to return a provider's calls, frequency of site visits, and lack of provider network orientation and education.

What should I do if I have a complaint?

To notify AmeriHealth Caritas Delaware of a complaint, providers may mail or fax a completed provider complaint form (PDF), a listing of claims (if applicable), and supporting documentation to:

AmeriHealth Caritas Delaware
P.O. Box 80101
London, KY 40742-0101
Fax number: 1-855-347-0023

Providers may file a written complaint about the plan’s policies, procedures, or any aspects of the plan's administrative functions, other than claims, within 45 calendar days.

For complaints about claims, providers may file a written complaint no later than 12 months from the date of service or 60 calendar days after the payment, denial, or recoupment of a timely claim submission, whichever is latest.