Pricing disputes and appeals

Pricing disputes

  • Use the Pricing Dispute Form (below) to disagree with the contractual pricing of a claim or claim line.

  • Before submitting a pricing dispute, we require you to validate your pricing dispute using all available resources.

Note: Pricing disputes are not appeals. They follow timely claims filing guidelines for claim adjustments.

Appeals

NEW: Submit claims appeals in Availity Essentials.

Detailed process information is outlined below for:

  • Retrospective Adverse Determination and Dispute process
  • Administrative Denial Disputes
  • Member Appeals
  • Rate Negotiation Requests under Balance Billing
  • External audit and investigation process
  • Provider contract termination process
  • Medical and reimbursement policy reconsideration process

Other disputes

Call our Provider Contact Center for disputes related to:

  • Claim denied for timely filing
  • Additional information requests
  • Claim denied as duplicate claim and payment not recieved

Submit claims appeals in Availity Essentials

Submit claims appeals using the Appeals application on Availity Essentials. The application streamlines the appeals process, making it faster and easier to submit appeals directly from the Claim Status screen.

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Note: Pricing disputes should continue to be submitted using the Pricing Dispute Form and our dedicated workflow.