Level II appeals
If we deny your first appeal, you may follow this process to file a Level II appeal.
Within one year of the date of service
Make your request
Level II appeal process
- Priority Health staff and/or third-party consultants will make a decision on your Level II appeal within 30 days of receipt.
- We will inform you of the outcome of the review either by remittance advice or by adverse determination letter within 5 business days of the decision.
What items are necessary for a medical appeal?
- Level 2 appeal form
- Appeal level letter (outlining what you are appealing and why we should reconsider our decision)
- New pertinent supporting documentation