Point32Health recognizes that questions or concerns may sometimes arise regarding claim payments, and our internal claims appeals process is designed to resolve such concerns quickly and efficiently, without the need for external escalation.
Handy resources for claims appeals submission
As valued partners in the care of our members, providers are expected to use our internal claims appeals process for timely and appropriate resolution. We encourage you to take advantage of the resources available to guide you in following this process, such as our online Provider Manuals and this Provider Claims Appeals flyer, which offers online and paper submission details and tips to ensure a smooth experience.
We also recently published this brief video intended to assist you in understanding and leveraging our claims appeals resources and processes.
Use Request for Claim Review Form to avoid rejections
As you are likely aware, providers should initiate claims appeals by submitting a completed Universal Provider Request for Claim Review Form – the standardized form developed by the Massachusetts Health Care Administrative Simplification Collaborative. Claims appeals submitted on paper on or after Jan. 1, 2027 without using this form will be rejected.
Along with the form, providers need to include all supporting documentation in order for Point32Health to be able to review an appeal request. Please refer to the Provider Manual pertaining to your member’s plan for further details about what documentation you need to include, what the filing limit is for claims appeals, and more, as this information varies by product.