New process for submitting post-claim appeals and medical records effective Mar. 19, 2020
Starting Mar. 19, 2020, we’re making a change to how you submit appeals and medical records that are related to an existing claim (i.e. post-claim), allowing us to return decisions faster. Instead of submitting these appeals and medical through your Secure Mailbox, you’ll now submit them in the Claims tool, following a few easy steps.
The process for submitting authorization appeals or medical records that are not related to a claim has not changed. Continue to submit these appeals using your Secure Mailbox.
We've created a new "Submit an appeal" button in the Provider Center to direct you to the correct tool.
Because the process for submitting an appeal differs depending on if the appeal has a related claim, we’ve created a new button in the Provider Center, titled Submit an appeal, to direct you to the appropriate tool.
When you click on this button you’ll be directed to a page where you can select the type of appeal you’re submitting. Select Pre-claim appeals for appeals not related to an existing claim. You’ll be directed to Secure Mailbox. Select Post-claim appeals for appeals that are related to an existing claim. You’ll be directed to the Claims tool.
How to submit a post-claim appeal or medical records within the Claims tool:
You’ll receive a confirmation screen and email from Provider Services with an inquiry number and additional information about your request.
For more information about our appeals process, including the difference between Level I and Level II appeals, see our Provider Manual.
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Special thanks to our
Priority Health Managed Care Committee Member
Flora Varga
from
Cancer, Hematology & Rheumatology Centers of West Michigan