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Get Wellmed Appeal Form

S rendered on members enrolled in a health plan where claims payment is administered by WellMed Medical Management. NOTE: Please submit a separate claim reconsideration request form for each reconsideration request No new claims should be submitted with this form. Do not use this form for formal appeals or disputes. Continue to use your standard appeals process for formal appeals or disputes. Please refer to your provider manual for additional details including where to send Claim Reconsideratio.

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