Claims Disputes

Claims Disputes Requests for Reconsideration of a Claim

All claim requests for claim reconsideration must be received within 180 calendar days from the date of notification of payment or denial was issued. A Request for Reconsideration is a communication (i.e., a typed letter) from the provider about a disagreement in the way a claim was processed. A Reconsideration Request should include:

  • The written reconsideration request must include a detailed description of the reason requested.
  • Sufficient identifying information which includes, at a minimum, the member name, and member ID number, date of service, total charges and provider name.
  • Original Claim Form
  • The provider should submit other supporting correspondence that supports the provider claim (member medical records).

The Medical Records will not go to the MRU team if: there is no claim form attached; there is no original claim number listed on the corrected claim form; there is no reconsideration form attached; and the original claim did not deny asking for medical records.

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