Reminder: Submit post-claim appeals and medical records through the Claims tool

On March 25, 2020 we changed how you submit appeals and medical records related to an existing claim (i.e. post-claim), which allows us to return decisions faster. Instead of submitting these appeals and medical records through your Secure Mailbox, you should submit them through the Claims Inquiry tool, following a few easy steps.

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

We launched a "Submit an appeal" button in the Provider Center to direct you to the correct tool.

The process for submitting an appeal differs depending on if an appeal has a related, existing claim. With that in mind, we've launched a new button in the Provider Center, titled Submit an appeal, which will direct you to the appropriate tool.

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 Inquiry tool.

Providers who are submitting a post-claim appeal through Claims Inquiry 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 Inquiry 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 Inquiry tool:

  1. Once inside the Claims Inquiry 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.