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ATCIC's appeals process provides a mechanism for Providers (or their authorized representatives, where appropriate) to appeal adverse determinations other than utilization management or resource allocation decisions.
An adverse determination is any decision by ATCIC or its review agent to:
- Reduce or suspend a Provider’s Network participation;
- Terminate a Provider’s Network participation with cause;
- Delay or deny payments; or
- Deny reappointment to the Network.
An adverse determination does not include denial of an initial appointment of a Provider to the Network, the issuance of a letter of warning or reprimand, or termination without cause. A provider has 15 calendar days to file an appeal after notification. For assistance in filing an appeal and for additional information, please call the Ombudsman at (512) 440-4086 or e-mail firstname.lastname@example.org.