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.


All post-service provider appeals, except FEP, must be submitted using the Appeals application on 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
  • 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 all post-service provider 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: Blue Cross and Blue Shield Federal Employee Program® (BCBS FEP®) appeals cannot be submitted via Availity. Pricing disputes should continue to be submitted using the Pricing Dispute Form and our dedicated workflow.