The new process is available through Availity.

What changed?

Only 2 simple options available: claim payment inquiry/reconsideration  and claim payment dispute/appeal.

Claim payment Inqury- this option should be used for the following:

• Retro eligibility issues
• COB- coordination of benefits
• Claim denied as a duplicate in error
• Auth denied for no auth on file and the service doesn’t require an auth or there is an auth on file- yet the claim got denied
• The following categories are avaiable:  reconsideration auth, reconsideration- eligibility, reconsideration pricing, reconsideration other

Claim Payment Dispute- this option should be used for the following:

• Claim denial- coding edits
• Past timely filling limit
• Non- covered benefits
• Absent/ denied auth
• The following categories are available: appeal- auth, appeal- benefit, appeal- code edit, appeal- contract payment, appeal- eligibility, benefits, COB, appeal- timely filling

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