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  • Regence Provider Appeal Form

Get Regence Provider Appeal Form

Regence Provider Appeal Form Use the appeal form to disagree with our decision that: Preauthorization was not obtained No admission notification was provided Claim denied for not meeting our medical.

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Once you find a perfect Regence Provider Appeal Form, all you need to do is adjust the template to your needs or legal requirements. In addition to completing the fillable form with accurate information, you might need to remove some provisions in the document that are irrelevant to your case. On the other hand, you might want to add some missing conditions in the original form. Our advanced document editing features are the simplest way to fix and adjust the document.

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Calling us at 866-781-5094 (TTY 866-773-9634). Writing a letter and sending it to us. Filling out a Member Grievance Form and sending it to us. You can get the form on this page or by calling the number above.

Mail or fax the completed form together with any supporting documents to: Fax: 919-765-4409. Fax (State Health Plan PPO): 919-765-2322. Member Rights and Appeals. Blue Cross and Blue Shield of North Carolina. P.O. Box 30055. Durham, NC 27702-3055.

If that individual is not identified, appeals may be faxed to 763-847-4010.

1 (888) 675-6570.

You, your legally authorized representative or your provider may file your appeal. If you need help filing your appeal, call us at 833-981-0213. If you are deaf or hard of hearing, you can call Utah Relay Services at 711 or 1-800-346-4128.

We handle all other pre-service appeals as follows: Standard - Must be submitted within 14 days of the original authorization denial. Blue Cross of Idaho will respond within 14 days of receiving the request. Expedited - Must be submitted within three days of the original authorization denial.

Call the phone number on the back of your member ID card. Customer Service will help you with the process. Call 1 (866) 749-0355. For member appeals that qualify for a faster decision, there is an expedited appeal process.

You must appeal within 60 days of getting our written decision.

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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
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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