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Zenith -- Provider Appeal for Network Exclusion Policy

Appeal Process

Zenith provides an appeal process for Provider’s that disagree with Zenith’s decision to Exclude the Provider from the network. This process will apply to all disputes related to Exclusion of a Provider unless law or contract requires a different process.

Providers may choose to initially contact Zenith telephonically to inquire about Zenith’s decision to Exclude the Provider from the Zenith Network. If the Provider makes a telephonic inquiry and

it does not resolve the Provider’s issues, Provider may also choose to seek a written

the Provider may submit a appeal without first making a

written appeal. The telephonic inquiry. If

Zenith’s determination on the written appeal does not resolve the Provider’s issues, may request a hearing. Hearings will be granted only if the Provider meets the hearing set forth in this policy.

the Provider criteria for a

All telephonic inquiries, appeals and requests for hearing from Excluded Providers must be directed to:

Telephonic Inquiries:

Provider Relations Telephone: 800-841-3988

Written appeals and requests for hearing:

Zenith Insurance Company Manager of Network Operations ATTN: Provider Exclusion Appeals 21255 Califa Street Woodland Hills, CA 91367 – 5021

Inquiries, appeals and hearing requests received by Zenith staff will be coordinated with Corporate Legal.

Submission of Written Appeal

All written Provider appeals must be submitted to Zenith within 30 days of the date the Provider was notified of the termination. The appeal must include:

  • 1.

    Provider’s name;

  • 2.

    license type and number;

  • 3.

    federal tax identification number;

  • 4.

    office address;

  • 5.

    office telephone and fax number;

  • 6.

    a narrative explaining why the Provider believes the original Exclusion decision was incorrect and why the Provider believes it should be overturned; and

  • 7.

    all supporting documentation, including medical reports, and any other information the Provider intends to rely upon in support of his or her appeal.

Rev. 2-09

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