![]() ![]() box listed on the EOB statement, denial letter or overpayment letter related to the issue being disputed. Submit online through the Explanation of Benefits (EOB) claim search tool – log in to the secure provider website via NaviNet®.The dispute processĪ practitioner or organizational provider may submit a dispute in one of four ways: The member appeal process applies to appeals related to pre-service or concurrent medical necessity decisions. For these types of issues, the practitioner/organizational provider appeal process only applies to appeals received subsequent to the services being rendered. ![]() Issues related to decisions made during the precertification, concurrent or retrospective review processes for services that require precertification. Issues related to decisions made during the claims adjudication process, including those that result in an overpayment (i.e., related to the provider contract, our claims payment policies, processing error, etc.).
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