Get Adjustment & Appeal Communication Process - Swhp

This guide provides a comprehensive overview of how to fill out the Adjustment & Appeal Communication Process - Swhp form online. Follow these steps to ensure your submission is complete and correct, facilitating a smooth reprocessing of your claims.

Follow the steps to complete your Adjustment & Appeal Communication Process - Swhp form.

1. Click the ‘Get Form’ button to obtain the form and open it in the online editor.
2. Fill in the review submission date, contact name, provider name, contact phone number, and provider number or NPI at the top of the form.
3. Provide the member's name, provider address, SWHP member ID number, SWHP claim number, and date of service in the respective fields.
4. Select the reason for your appeal from the list provided. Ensure that you choose the option that best represents your request.
5. Attach any pertinent supporting documentation such as surgical notes, office visit notes, pathology reports, and/or medical records, if applicable.
6. Double-check all information for accuracy and completeness. If any fields are left unfilled, the request may be returned for correction.
7. Once all information is complete, save your changes and download the form. Ensure it is ready for submission by mail.
8. Print the completed form and any attachments, and mail them to the specified address: Scott & White Health Plan, Attn: Provider Appeals, P.O. Box 21800, Eagan, MN 55121-0800.

Submit your Adjustment & Appeal Communication Process - Swhp form online today for a timely review.