FYI

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.

Claim disputes begin with claim adjustments

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.

An adjustment didn’t solve my issue. How do I dispute a claim?

When adjustments don’t solve your issue, opening a dispute is the next step. Just log into Provider Tools then follow these steps.

1. On the Provider Tools landing page, select My claims. This section will display all the claims you’ve submitted, regardless of the method you used to submit them.

2. Search for a claim. You can search your patient’s name or the claim ID. Once you’ve entered the information, click Search claims.

3. View a claim. Just click on the claim ID to view the claim.

4. Choose a contact email address. You can choose from your practice’s email address or the email address used to create your Provider Tools account, or select Other to enter a new email address.

5. Begin the dispute process. You’ll need to scroll to the bottom of the claim page and click the Dispute the decision link. Please note that claim disputes will only be accepted after a claim adjustment has been processed.

6. Describe why you’re disputing the claim. After you begin the process, you’ll be directed to the claim dispute form. Here you can enter your reason for disputing the claim and attach any supporting documents.

7. Click Submit and you’re done! Once your submission is complete, you’ll see a confirmation message and you can rest easy knowing that we’ll be in touch with the results of your dispute.

What’s the benefit of submitting disputes online?

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.