Provider Grievances

HAP CareSource™ will thoroughly investigate each provider complaint using applicable statutory, regulatory and contractual provisions, collecting all pertinent facts from all parties and applying the HAP CareSource written policies and procedures. Providers are permitted to submit complaints to HAP CareSource regarding HAP CareSource’s policies, procedures or any aspect of HAP CareSource’s administrative functions. All provider complaints should be clearly documented. Matters involving denials or claims payment should be submitted through the appropriate claim payment dispute or appeals process.

Providers have 30 calendar days from the date of the incident to file a provider complaint:

HAP CareSource
Attn: Grievances & Appeals
P.O. Box 1025
Dayton OH 45401-1025
Phone: 1-833-230-2102

HAP CareSource will resolve all provider complaints within 90 days. We ensure that HAP CareSource executives with the authority to require corrective action are involved in the provider complaint process. HAP CareSource also allows providers to consolidate complaints or appeals of multiple claims that involve the same or similar payment or coverage issues, regardless of the number of individual members or payment claims included in the bundled complaint or appeal.