Availity Essentials Appeals application

The Appeals Application:

  • Streamlines the appeals process by making it easy to submit appeals directly from the Claim Status screen
  • Gathers all required information about the claim being disputed
  • Prevents duplicate appeal submissions

The Appeals dashboard shows the status and history of submitted appeals, eliminating the need to contact us for status information. For the Appeals Application:

  • The maximum number of files to upload is 10.
  • Files must be larger than 3 KB.
  • Maximum individual file size is 60 MB with a total of 150 MB across all files.
  • Supported file types include: .csv, .doc, .docx, .gif, .html, .jpg, .jpeg, .msg, .pdf, .png, .ppt, .pptx, .rtf, .tif, .tiff, .txt, .xls, and xlsx.

Pre-authorization determination appeals

Pre-authorization determinations appearing on the Availity Essentials Authorization dashboard can be appealed using the appeals application. Pre-authorizations appear on the dashboard when they are submitted using the Authorization application or by submitting an inquiry and pinning the authorization to the Authorization dashboard.

The following pre-authorization determinations appeals cannot be submitted via Availity Essentials:

  • Pharmacy pre-authorization
  • Specialty medication pre-authorization 
  • Pre-authorizations submitted via eviCore healthcare (physical medicine) or Carelon  Medcial Benefits Management (radiology, sleep medicine or cardiology) 

Post-service claims appeals

All post-service provider claims appeals must be submitted via the Appeals Application on Availity Essentials.

Note: The only disputes and appeals that should not be submitted via Availity Essentials are:

Accessing the Appeals application

Access the application from Availity Essentials: Claims & Payments>Appeals. If you do not have access to the application, contact your Availity Essentials administrator and request the Claim Status role.

Appeals can be initiated from the Claim Status screen by selecting Dispute Claim.

Get trained for free

View the training options available by clicking the Help & Training link in the Availity Essentials menu. View user guides on Availity Essentials: Help & Training>Find Help>Appeals. A recorded training demonstration is also available by searching for Appeals: Help & Training>Get Trained.

Availity Essentials Appeals application messaging

If you receive one of the following messages when trying to dispute a claim using the Appeals application, review the explanation for alternative options for submitting your dispute.