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

Submit pre-authorization determination and post-service provider appeals, except FEP, via 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 appeals in Availity Essentials

Submit pre-authorization determination and all post-service provider claims appeals using the Appeals application on Availity Essentials.

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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.