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.
What makes a good appeal?
Our Reimbursement team shares what you can and can't appeal, what to include in your appeal, how to request reviews for multiple claims and more.
Provider manual
- Authorizations
- Billing & payment
- Procedures & services
- Reviews & appeals
- Drugs
- Medical policies
- Provider forms
- Seeing Cigna members
- Requirements & responsibilities
- Clinical resources
- News
- Fraud, waste & abuse policy
- Join our networks
- Check patient eligibility
- Data exchange
- Set up electronic claims
- Set up electronic funds transfer (EFT)
- Check claim status