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  • Buckeye Claim Adjustment Form

Get Buckeye Claim Adjustment Form

COB Dispute & Adjustment Request Form Please utilize this form to request a review of claim payment/recovery. Matters addressed via this form will be acknowledged as requests for adjustment only.

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Contact support

Complaints and Appeals Call the Member Services department at 1-866-246-4358 (TDD/TTY: 1-800-750-0750) Fill out the form in your member handbook. Call the Member Services department to request they mail you a form. Visit our website at .buckeyehealthplan.com.

To contact us you can: Call the Member Services department at 1-866-246-4358 (TDD/TTY: 1-800-750-0750) Fill out the form in your member handbook. Call the Member Services department to request they mail you a form.

Authorization and Coverage Complaints A provider has thirty (30) calendar days from Ambetter's notice of action to file the appeal.

Your appeal must be requested within 60 calendar days of the decision you are appealing and the request must include: Your name. Address.

Submit the Adjustment within 180 days from the date of the EOP.

225.2573 ext: 6075525 or via e-mail at: EDIBA@centene.com Payor ID 68069 Visit .buckeyehealthplan.com Click Provider Home/Resources/ Electronic Transactions (EDI).

The address to mail a provider appeal is: 4349 Easton Way, Suite 120, Columbus, OH 43219. Providers may file a provider appeal electronically using the Buckeye provider portal.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232