CHP+ Appeals and Grievances

A grievance is an action you take when you want to submit a complaint about your dental provider, the care they provided, DentaQuest, or other dental care concerns. Grievances are not for issues related to decisions made about services under your dental plan.

Here are some examples:

• The dental office asks you to pay a coinsurance amount that isn’t listed on the Coinsurance and Procedure Code List
• A dentist listed in the DentaQuest Participating Dentist directory refuses to work with the CHP+ Dental program
   

Choose one of the following ways to submit your complaint or grievance:

• Call DentaQuest at 888-307-6561 (State Relay 711) Monday–Friday, 8a to 5p MT
• Online through the Member Portal by going to the Help Page, clicking "Contact Us", and then “Create Help Request”
• In writing:
  DentaQuest Complaints and Grievances
  PO Box 2906
  Milwaukee, WI 53201 
   

An appeal is an action you can take when you do not agree with a decision DentaQuest made about a service under your dental plan.  For example, when a service you asked for is denied.

You have the right to appeal if a service is denied. Here are examples of when you can appeal:

• When a service you asked for is denied
• When your request to challenge costs (like co-pays, premiums, deductibles, etc.) is denied.
   

You must submit your appeal within 60 days of the date of the original Explanation of Benefits (EOB). Choose one of the following ways to submit your appeal:

• Call DentaQuest at 888-307-6561 (State Relay: 711) Monday–Friday, 8a to 5p MT
• In writing to:
  DentaQuest Appeals
  PO Box 2906
  Milwaukee, WI 53201
   

A dentist, or someone you choose, can file an appeal on your behalf with your permission.

If you want someone else to represent you, let DentaQuest know in writing. Include their name, address, and phone number. If you want to access any dental records, you or a legal guardian must give written permission to your dentist.

Filing an appeal will not affect your CHP+ Dental Program coverage. DentaQuest cannot take away your benefits because you file an appeal.

If you agree with the appeal decision, you do not need to do anything else. If you think the decision is wrong, you have the right to request a State Fair Hearing. A State Fair Hearing is when an Administrative Law Judge (ALJ) reviews DentaQuest’s decision. To qualify for a State Fair Hearing, you must first go through the internal appeal process with DentaQuest.  You must file your appeal in writing for a State Fair Hearing within 120 days of the date on your appeal resolution letter.  Your letter must include:

• Your Name
• Your signature (if mailing or faxing)
• Your Mailing address
• Your Phone number
  
  

Helpful to include, but not required: 

• A case number or member ID
• Reason you disagree with the decision
• A copy of the decision letter
• A request for an interpreter or other accommodations (if needed)
  
  

Choose one of these ways to submit your letter:

• Mail and In-person:
  Office of Administrative Courts
  1525 Sherman Street, 4th Floor
  Denver, CO 80203
• Phone: 303-866-2000
• Fax: 303-866-5909 (10 pages or fewer; otherwise, mail your request)
• Email: oac-gs@state.co.us
  
  

You have the right to ask someone to request the State Fair Hearing on your behalf as your authorized representative.  You can also ask your provider to request the State Fair Hearing for you.  At the State Fair Hearing, you can speak for yourself or ask your authorized representative or provider to speak on your behalf.

The Office of Administrative Courts will contact you by mail with the date, time and place for your hearing with the Administrative Law Judge.

If waiting for a hearing seriously risks your life or health, you can ask for an expedited (faster) hearing.

To request an expedited hearing:

• Write the letter of appeal using the instructions above for how to appeal
• Include in your letter of appeal:
  • Your request for an expedited hearing
  • Explain how and why your life, health, or ability to regain, attain or maintain maximum function would be at serious risk if you do not have an expedited (faster) hearing
  • Provide additional information to explain why you need an expedited hearing
  • Mail, fax, email or bring your letter using the same instructions above for how to appeal
    
    

If your request for an expedited hearing is approved, you will be contacted by phone to set up a hearing date and time.

If your request for an expedited hearing is denied, you will still get a formal hearing through the Office of Administrative Courts. They will mail you a letter with the date, time and place for your hearing with the Administrative Law Judge.

For questions about your child’s benefits or dental services, call customer relations at 1-888-307-6561 (TTY 711), Monday–Friday, 8a to 5p MT

I’ve recently switched from CHP+ to Health First Colorado (or from Health First Colorado to CHP+), what grievance process do I follow?

When filing your grievance, please use the process of the program you were under when the service occurred. For example, if you had a procedure done while under Health First Colorado and you want to file a grievance you should use the Health First Colorado process. Please contact customer service if you need support. Call 855-225-1729 (State Relay: 711), between the hours of 8a to 5p MT.

I’ve recently switched from CHP+ to Health First Colorado (or from Health First Colorado to CHP+), what reconsideration (or appeal) process do I follow?

When filing your reconsideration (or appeal), please use the process of the program you were under when the service occurred. For example, if you had a procedure denied while under Health First Colorado and you want to file a reconsideration (or appeal), you should use the Health First Colorado process. Please contact customer service if you need support. Call 855-225-1729 (State Relay: 711), between the hours of 8a to 5p MT.