For pharmacy requests or drug authorization appeals, visit our drug information page.
Claim disputes & authorization appeals
Use the instructions on the pages below to submit reviews and appeals requests for medical and behavioral health claims.
Note: A Level 1 claim dispute decision is required* to process a Level 2 claim dispute (*Exception: Medical authorization appeals)
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.