New Claims System Update

Appeals and Reconsiderations

remove Claims Appeals

Provider Portal

For IntegraNet Claims.

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Appeals

For 2023 EOPs. Use the login below.

To download a copy of Claim Reconsideration-Appeal Process FAQ, click here.

IntegraNet has established a unique Claims Appeal process that permits providers to dispute IntegraNet’s decisions for claim denials.
This process addresses claim denials, including but not limited to:

  • Timely Filing
  • Bundled, Unbundled, or Incedental Procedure denials
  • Non-Covered procedures
  • Underpayments disputes
  • Eligibility denials

    • Contracted providers must submit their request for Reconsideration to IntegraNet in accordance with their contract or within 120 calendar days from the date of the Explanation of Payment (EOP) when the contract does not specify a timeframe. Non- contracted providers must submit their request for Reconsideration within 60 calendar days from the date on the Explanation of Payment (EOP) along with a waiver of liability form is required for submission.

    Two Methods of Appeal Submission
    FAX MAIL ELECTRONIC FORM
    Appeals & Grievances
    RE: Appeal/Reconsideration
    1-800-783-9885    		 Appeals & Grievances
    2900 N. Loop West 7th Floor
    Houston, TX 77092    		 IntegraNet Claims Appeals/Reconsiderations
    Appeal Status:
    IntegraNet Provider Portal Support/Appeal Status
  • DO NOT submit medical records to A&G unless formally requested by a representative, this process will not review for Medical Necessity exceptions. Please see prior authorizations.
  • Claim status inquiries that DO NOT have an active Appeal/Reconsideration case please see the
  • DO NOT send paper/electronic CMS claim forms to A&G for processing (including corrected claims).
  • DO NOT submit multiple members on the same appeal submission, these will not be accepted.