Providers who believe a claim has been wrongfully denied, either fully or partly, should contact our Member Advocate Team at (833) 726-2123 for review. We may be able to resolve your issue quickly outside of the formal appeal process.
If we're unable to resolve your issue over the phone, you may submit a written appeal. You will have 180 days from receiving the denial notification to submit an initial appeal with us.
All appeals must include:
- The name of the member
- The member’s social security number
- The group name or identification number
- A statement in clear and concise terms of the reason or reasons for disagreement with the handling of the claim
- Any material or information that the member has which indicates that the member is entitled to benefits under the plan
All appeals should be mailed to:
P.O Box 660675 #35777
Dallas, TX 75266-0675
If you have any other questions please feel free to call us at (833) 726-2123 or send an email to email@example.com.