This section provides detailed information on how to submit an administrative appeal along with policies related to each appeal type.
A provider may submit an administrative appeal for reconsideration for a denied claim. The administrative appeal process is only applicable to claims that have already been processed and denied. An administrative appeal cannot be requested for services rendered to a member who was not eligible on the date(s) of service, or for benefits that are not administered or covered by the Plan. For further information on appeals, please see section 10 of the Plan’s Provider Manual.