The claim adjustment request may be submitted online, by telephone, by fax or in writing within 120 calendar days of the provider being notified of the original claim determination. An extra five calendar days is allowed for mail delivery.
Upon receipt of a claim adjustment request, we review and document the substance of the request.
We then gather the appropriate documentation, including any additional information available, and perform a complete investigation of the substance of the request. Providers are encouraged to submit claim adjustment requests online through the Provider Portal to help expedite the process. Submitting online also allows for quick response and upload capabilities, should we require additional supporting documents to route or process the inquiry.