Get Interactive Appeal Form Final Aug 2013 Pdf

If you have a concern about how a claim processed, you can request a claim review, also called an allowable charge review. (Note: This process is separate from the claims appeal process, which is only for charges denied as "not covered" or "not medically necessary.")

Claim review contractors identify suspected improper billing through error rates produced by the CERT Program, vulnerabilities identified through the Recovery Audit Program, claim data analysis, and evaluation of other information (for example, complaints).

Registered providers may submit corrected claims or dispute a claim using Tufts Health Plan's secure Provider portal. Follow the instructions when submitting online claim adjustments. After the transaction has been completed, providers will receive a tracking number as confirmation the adjustment has been received.

Mail initial paper claims to: Tufts Health Public Plans – Paper Claims Submissions P.O. Box 189 Canton, MA 02021-0189 Note: Claims requiring additional documentation must be submitted on paper.

Our address for submitting corrected claims, disputes, appeals and medical records has not changed. You can continue to submit these requests to: Tufts Health Public Plans, P.O. Box 524, Canton, MA 02021.

Members who are unsure can contact their employer to determine if their plan is an ERISA plan. You may also submit a verbal appeal by calling a Member Services Specialist at 888.257. 1985, who will record your appeal and forward it to the Appeals and Grievances Department.

noun. : a document with information about why a person should be given money. filled out an insurance claim form.

The review may also include determination of eligibility of the claimant or beneficiary or of the provider of the benefit; determination that the benefit is covered or not payable under another policy; or determination that the service was necessary and of reasonable cost and quality.

Late charges applied to Tufts Health Plan Commercial claims must be received by Tufts Health Plan within 90 days of the date of service (for professional or outpatient claims) or date of discharge (for inpatient or institutional claims).