Commercial

You must wait 45 days after submitting a claim to submit a Level 1 claim dispute, and you must use the Level 1 dispute process before you can file a Level 2 claim dispute.

Note: A Level 1 claim dispute decision is required to process a Level 2 claim dispute.

Level 1 claim dispute

Level 2 claim dispute

Medicaid

For the most part, claim disputes under Medicaid follow our process for commercial plan claim disputes, with the addition of the binding arbitration process.

Note: A Level 1 claim dispute decision is required to process a Level 2 claim dispute. 

Level 1 claim dispute

Level 2 claim dispute

Binding arbitration