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FYI - Partnering with you to create healthy smiles


Partnering with you to help create healthy smiles

Having trouble with a claim? Try Provider Tools

When issues arise with claims processing, skip a complicated process to get them resolved. Here’s what you need to know about using Provider Tools to help solve these issues.

Submitting disputes online empowers you

With claim disputes on Provider Tools, you can manage your requests from a single 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.

Disputing a claim? Start with an adjustment

The first step in the claim dispute process is filing a claim adjustment. Claim adjustments give us an opportunity to review and correct any errors with a claim as quickly as possible. Regardless of how they were submitted, all claims are eligible for adjustment review within 90 days of submission.

To request an adjustment, log in to your Provider Tools account to begin the process (or register, if you don’t have one yet.)

An adjustment didn’t work? Move on to a dispute

If a claim adjustment didn’t solve your issue, move on to a claim dispute. Once you’ve logged into Provider Tools, follow these steps.

  1. On the Provider Tools landing page, select My claims to see all your submitted claims.
  2. Search for a claim with your patient’s name or the claim ID, then click Search Claims.
  3. Click on the claim ID to view the corresponding claim.
  4. Choose whether you want to be contacted at the practice’s email address or your Provider Tools email address, or select Other to enter a new email address.
  5. Click the Dispute the decision link. Please note, you can only begin a claim dispute after a claim adjustment has been processed.
  6. Tell us why you’re disputing the claim and attach any supporting documentation.
  7. Click Submit and view a confirmation message for your dispute. Our Grievance and Appeals team will be in touch with a response within 45 days.

Want to learn more about Provider Tools? Check out one of our webinars.