14 CLAIM SUBMISSION AND ADJUDICATION PROCEDURES
14.13 How to Submit a Claim Payment Dispute
We have several options when filing a claim payment dispute. They are described below.
Verbal (Reconsideration only): Verbal submissions may be submitted by calling our claims analyst at
(832) 320-7220.
Web Portal (Reconsideration and Claim Payment Appeal): Reconsiderations and claim payment appeals via the secure Payment Appeal Tool at https://inetclaims.zendesk.com
- by submitting a ticket and supporting documentation. You will receive immediate acknowledgement of your web submission.
Written (Reconsideration and Claim Payment Appeal): Written reconsiderations and claim payment appeals should be mailed, along with the Claim Payment Appeal Form or the Reconsideration Form to:
IntegraNet Health
Claims Department - Provider Disputes
2900 North Loop West, #700
Houston, TX 77092
Required Documentation for Claims Payment Disputes
IntegraNet requires the following information when submitting a claim payment dispute (reconsideration or claim payment appeal):
- Your name, address, phone number, email, and either your NPI or TIN.
- The member’s name and their IntegraNet or Medicare ID number.
- A listing of disputed claims, which should include the IntegraNet claim number and the date(s) of service(s).
- All supporting statements and documentation.