New provider appeal process and form effective 4/1/17

UCare will implement a formal provider appeal process effective April 1, 2017. When a provider is requesting an adjustment, recoupment or appeal on a claim, the new, universal Claim Reconsideration Request Form must be thoroughly completed and submitted to UCare along with additional documentation to support the appeal request. Providers must begin using the new form for appeals, adjustment and recoupment requests by April 1, 2017. The previous Adjustment/Recoupment Request Form will no longer be accepted after April 1, 2017. If the previous form is submitted to UCare after April 1, 2017, it will be returned immediately to the provider via the method it was received and no action will be taken on the request until the new Claim Reconsideration Request Form is submitted. UCare will review claim appeal requests upon receipt and a determination will be made within 60 calendar days. After review, providers will receive a written notice of appeal determination.

Source: https://www.ucare.org/providers/Documents/healthlines_2017_March.pdf?utm_source=March%202017%20edition%20of%20UCare%20health%20lines&utm_campaign=March%202017%20edition%20of%20UCare%20health%20lines&utm_medium=email