Requests for claim review
We offer our providers the opportunity to submit a request for claim review, which includes corrected claim submissions. You can submit a request for claim review in writing or by calling us. We must receive your request for claim review within 60 days of the initial explanation of payment (EOP) date. Your request for claim review must include the following information:
- Date of service
- Reason for request
- Claim number (if applicable)
- Clinical information (if applicable)
- Contact name and address for the request
Corrected claims must also include:
- Clear identification of corrected and/or added information
- The words "corrected claim" on the claim
You can use the Request for Claim Review Form to ensure we have all the information necessary to begin reviewing your request.
Please refer to our Provider Manual for information on member appeals.
We may deny payment of a claim if you:
As a reminder, always be sure to verify your Network Health patient's eligibility on the date of service to ensure claims payment.
Submit a request for claim review, including corrected claim submissions, by mail to:
Attn: Provider Appeals Team
101 Station Landing, Fourth Floor
Medford, MA 02155
You can also submit an initial request for claim reivew by calling us at 888-257-1985.