New process for submitting post-claim appeals and medical records coming soon

Update: Effective Mar. 25, 2020, the new process for submitting post-claim appeals and medical records is live. Providers should use the new process, outlined below, to submit post-claim appeals and medical records. 

We’re making a change to how you submit appeals and medical records that are related to an existing claim (i.e. post-claim), allowing us to return decisions faster. Instead of submitting these appeals and medical records through your Secure Mailbox, you’ll now submit them in the Claims tool, following a few easy steps.

The process for submitting authorization appeals or medical records that are not related to a claim will not change. Continue to submit these using your Secure Mailbox.

We're launching a new "Submit an appeal" button in the Provider Center to direct you to the correct tool.

Because the process for submitting an appeal differs depending on if the appeal has a related claim, we're launching a new button in the Provider Center, titled Submit an appeal, to direct you to the appropriate tool. The button will go live when the new process goes into effect. 

When you click on this button you’ll be directed to a page where you can select the type of appeal you’re submitting. Select Pre-claim appeals for appeals not related to an existing claim. You’ll be directed to Secure Mailbox. Select Post-claim appeals for appeals that are related to an existing claim. You’ll be directed to the Claims tool.

Providers who are submitting a post-claim appeal through Claims tool will no longer need to submit an appeals form along with their appeal. All information previously required on the appeals form will now be entered via the Claims tool, or automatically pulled in from existing claims info and attached to the appeal.

How to submit a post-claim appeal or medical records within the Claims tool:

  1. Once inside the Claims tool, use the Claim Number Search tab to search for and select the related claim.
  2. In the Remittance Advice that opens, click Contact us
  3. In the What is your message about? drop down menu, select Appeals or Submit medical records
  4. If submitting an appeal, choose whether this is your first or second appeal attempt (Level I or Level II)
  5. Specify the claim line in question, then enter your name, phone number and a message explaining the appeal
  6. Upload attachments (e.g.supporting documentation)
  7. Click Send

You’ll receive a confirmation screen and email from Provider Services with an inquiry number and additional information about your request.

For more information about our appeals process, including the difference between Level I and Level II appeals, see our Provider Manual.