Disputes & Appeals
Information to guide you
The dispute process made simple
The dispute process allows you to disagree with a claim or utilization review decision.
Discover how and when to submit a dispute. Learn about the timeframe for appeals and reconsiderations. And find contact information for different issues.
Medicare Appeals
Medicare appeal process
Discover how and when to appeal payment decisions.
Hospital discharge appeal process
Medicare patients can appeal a hospital discharge decision. This is called a Quality Improvement Organization (QIO) review.
Have more questions?
Read our FAQs. We have answers to many questions, including:
- What is a dispute?
- What is the procedure for disputing a claim decision?
- What is a reconsideration?
- What is a Level 1 appeal?
State-specific information
We have state-specific information about disputes and appeals. We also have a list of state exceptions to our 180-day filing standard. Exceptions apply to members covered under fully insured plans.
State-specific forms about disputes and appeals
State exceptions to filing standard
