Administrative appeals or claims reviews are conducted on claim denials.

If you’d like to:

• Make a correction to a previously submitted 1500 or UB-04 claim, then submit a replacement claim, not an appeal.
• Submit an appeal, use Appeals Manager or send us a completed Request for Claim Review Form.
  • All first-level provider appeals to request a claim review must be submitted within 180 days of the initial claim being denied or processed to the appropriate address listed below.
  • If you disagree with the first-level provider appeal determination, you may submit a second-level provider appeal within 60 days of receipt of the first-level provider appeal determination.
• Check the status of an appeal, use Appeals Manager.

Where to mail your completed documents