New Claims System Update

Provider Manual
heartbeat_stet

14 CLAIM SUBMISSION AND ADJUDICATION PROCEDURES

14.24 Provider Liability Appeals

A provider liability appeal is a request for IntegraNet to review a decision by IntegraNet to deny payment (without member liability) for services already rendered. To submit a request for appeal, send in a copy of the Explanation of Payment received along with all medical records to IntegraNet. The provider is responsible for sending in all necessary information, after which time the appeal will be reviewed and a determination rendered based on the information provided.