next gen

what is the 3 minimum provider information that must be listed in provider appeal

• Provider name

• Provider contact info

• member name

• provider tax ID

which below are examples of disputes that we can accept?

• letter to the health plan stating that a claim was filled in a timely manna which includes the minimum info and claim data

• EOB with a note of appeal type and claim info included

• a completed provider dispute form

• a call from the provider to member service

how many days do the provider have to submit a dispute to health plan, from the date of the initial decision of the claim?

• 15

• 2

• 356

• 365

how many days does the health plan have to send ack letter, if we received PDR appeal electronic?

• 15

• 2

• 356

• 365

how many days do health plan have to send ack Letter if appeal was received by mail?

• 15

• 2

• 356

• 365

Where can the provider get a Provider Dispute Resolution form

• On the health plan website

• with copy of EOB sent

• They are mailed, emailed, or faxed to the provider on request.

Which Department at Elevance Health handles the Meet and Confer Process?

• Grievances and Appeals

• Provider Escalations

• member services

• legal

which option below is the correct term for when we have denied provider appeal?

• overturn

• partial overturn

• upheld

• denied

what option below is the correct term for when we have approved the provider appeal fully?

• partially overturn

• upheld

• approved

• Overturn

which term below is correct when we have only approved part of the provider appeal?

• overturn

• upheld

• partially overturn