March 23, 2023
Clinical appeals can be submitted thru our provider portal electronically
- Primarily address utilization management authorization denials in addition to claim denials related to lack of approved authorizations
- For these appeals, our system will generate a reference number for the submission. You may use this reference number to check on the status of an appeal. Our Customer Service (CS) agents can verify status of your appeal with this reference number via the chat function in the portal or you may call our CS line.
Claim policy appeals or disputes may also be submitted thru our provider portal electronically
- These primarily address issues with the adjudication of the claim related to under/overpayment, bundling, COB, claim edits etc.
- Unlike clinical appeals, the system does not generate a reference number for these submissions. This does not mean, however, that you cannot inquire on the status of the submission. You may inquire on status with the respective claim ID via the chat function in the portal or you may call our CS line.
