Disputing a claim should be as easy as possible. Now instead of dealing with a complicated process, you can submit and track claim disputes online directly from your Provider Tools account. Here’s what you need to know to get started.
Before filing a dispute, you need to file a claim adjustment first. Filing an adjustment gives us the opportunity to review and correct any errors in a claim as quickly as possible. All claims submitted within the last 90 days are eligible for adjustment review, regardless of how they were submitted.
Claim adjustments can also be filed online. First, you’ll need a Provider Tools account. If you don’t already have one, it’s easy to register. Just follow the three-step process outlined on the registration page.
When adjustments don’t solve your issue, opening a dispute is the next step. Just log into Provider Tools then follow these steps.
Submitting adjustments and disputes online empowers you to take charge of the appeal process. With the addition of claim disputes to Provider Tools, you can now manage these requests from a single centralized location. The real-time dispute dashboard lets you see how many disputes have been submitted, how many are currently undergoing review and how many have been processed. After you submit your dispute, you’ll receive a written response from our Grievance and Appeals team within 45 days.
Stay tuned for more updates. If you’re interested in learning more about Provider Tools, consider attending an educational webinar.