Claim disputes & authorization appeals

In the pages linked below, you’ll find detailed instructions on how to ask us to reconsider a decision we’ve made, whether coverage and payment or authorizations denials.

Page last updated on: 1/30/26
For pharmacy requests or drug authorization appeals, visit our drug information page. 

Claim disputes

Use the instructions on the pages below to submit claim disputes for medical and behavioral health claims.

Note: A Level 1 claim dispute decision is required* in prism to process a Level 2 claim dispute (*Exception: Medical authorization appeals)

Medicare claim disputes

Non-Medicare claim disputes

Authorization appeals

Use the instructions on the pages below to submit appeals for denied medical and behavioral health authorizations.

Note: If you have a denied outpatient, home health, DME, elective inpatient or behavioral health authorization on file, submit an authorization appeal before performing the service – not a post-claim review request. Effective June 2, 2025, we won't review these cases for medical necessity post-claim if a denied authorization is on file.

Medicare authorization reviews & appeals

Non-Medicare authorization reviews & appeals