Reviews & appeals

How to ask us to reconsider coverage and payment

Commercial

You must wait 45 days after submitting a claim to request a review, and you must use the review process before you can file an appeal.

Medicare

Medicare rules are different from commercial and Medicaid plan rules. Here's how to ask Priority Health to reconsider an adverse coverage or payment decision.

Medicaid

For the most part, reviews and appeals under Medicaid follow our process for commercial plan reviews and appeals, with the addition of the binding arbitration process.