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. 

Denials

We may deny payment of a claim if you:   

• Do not include your NPI number and your tax ID number 
• Request a service that is not a covered benefit
• Do not get prior authorization (if necessary)
• Do not provide enough clinical information to support the requested service
• Submit an incomplete claim form
• Submit the claim outside of our required time frame 

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:

Network Health
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.