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.