Provider Central

To perform an inquiry in Appeals Manager, have the following ready:

• Member ID number
• Member’s date of birth
• Claim number or appeal number

Inside Appeals Manager, click Begin by searching for a claim or appeal.

Enter the member ID number, date of birth, and either the claim number or the appeal number. If you search by appeal number, include the prefix “D.”

If results are found, your screen might look like the screen shown below. Click an item to view details.

The appeal status appears directly under the heading, Appeal details.

Appeals with an "open" status will include an option to Edit & upload (supporting documentation).

In Appeals Manager, you can appeal a claim denial by following these steps:

1. Create an appeal case number
2. Attach documentation to the case

Create an appeal case number

To begin, search for your claim and click the claim number to view details. If your claim is eligible to be appealed, you’ll see a Start an appeal button.

When you click Start an appeal, a short form will appear below the claim details.

Choose an appeal category, enter a dispute reason, and click Submit appeal to create the case number.

Attach documentation to the case

To attach supporting documentation, edit the case you created. Click the appeal number to view the appeal details. When the appeal details appear, click Edit & upload.

You will be prompted to upload a file and add a description or notes.

You can upload a maximum of two documents per appeal.

You can download determination letters for appeals finalized on or after April 1, 2026. Perform a search and click the appeal case number to view the appeal details. A link to the determination letter will appear under the row listing the date of service.

Q: When should I submit a replacement claim instead of an appeal?
A: Please refer to our Replacement Claims page on Provider Central.

Q: What do I do if I disagree with my appeal’s determination?
A: You have the right to submit a second appeal within 60 days from the determination date of the first appeal. Please note that you may only submit up to two appeals for the same denied claim.

Q: I see that my appeal is currently under review. When will a determination be made?
A: We process appeals in the order we receive them. Once your appeal is reviewed, we’ll notify you of our decision by letter, fax, or an adjusted Explanation of Benefits.