Peoples Health protects the right of providers to address inquiries and concerns, as well as to request claim adjustments for payment of services for which a provider is, or believes he or she is, entitled. We will provide a fair and timely review and resolution.
All contracted providers and their representatives have the right to make inquiries regarding decisions made by or on behalf of Peoples Health regarding payment for services for which the provider feels entitled, as well as inquiries regarding plan rules and processes, including but not limited to benefit verification, eligibility, authorization requirements, claims payment inquiries and acceptance of complaints. Discussion of patient information is limited to the rules and regulations of the HIPAA Privacy Act.
A claim adjustment request is a request to change our payment decision if the provider believes there was a plan error when a service claim was originally processed. Providers have the right to contact the plan about claim inquiries or requests for adjustments. Submit request through the Provider Portal, under the Claims tab, for the fastest service. Alternatively, contact our provider services department through a dedicated call center or submit written comments, documents and other information by fax or mail to support the request. Claim adjustment requests are processed within 60 calendar days of receipt of the request.