Changes to medical coding and administrative appeals process coming Nov. 1

Your needs as a network partner are always top of mind for our team. We're constantly seeking ways to innovate and evolve to ease your burden. That's why we're excited to share upcoming changes that will simplify medical coding and administrative appeals.

What's changing?

Starting Nov. 1, you'll follow this process:

  1. Submit an Informal Review request through our Claims Inquiry tool. If you're unsatisfied with the outcome of this review, you can then:
  2. File a Level 1 appeal with all supporting documentation, within 180 days of the first remittance advice, using either our Claims Inquiry tool or Secure Email.

This new process removes the Level II appeal for post-claim appeals and concentrates the timeframe for Level 1 appeals, to make sure appeals are processed and finalized as quickly and accurately as possible for you and your patients. With this shift, it's important to note that duplicate Level 1 appeals won't be accepted.

For more details, see our Reviews & appeals webpage.

Who does this change affect?

This change affects all participating providers and all non-participating providers, except for non-contracted Medicare providers. Non-contracted Medicare providers must continue to follow the CMS regulations for submitting appeals.