Use the Pricing Dispute Form (below) to disagree with the contractual pricing of a claim or claim line.
- Before submitting a pricing dispute, we require you to validate your pricing dispute using all available resources.
Note: Pricing disputes are not appeals. They follow timely claims filing guidelines for claim adjustments.
Submit pre-authorization determination and post-service provider appeals via the Appeals application on Availity Essentials.
Detailed process information is outlined below for:
- Retrospective Adverse Determination and Dispute process
- Administrative Denial Disputes
- Member Appeals
- Rate Negotiation Requests under Balance Billing
- External audit and investigation process
- Medical and reimbursement policy reconsideration process
Call our Provider Contact Center for disputes related to:
- Claim denied for timely filing
- Additional information requests
- Claim denied as duplicate claim and payment not recieved