At this time, we are experiencing a high volume of claims appeals, which has impacted processing timeframes for some lines of business. We strive to deliver excellent service to our provider partners, and are actively working to shorten claims appeals processing timeframes.
We have made meaningful progress in reducing turnaround times for our Public Plans, and providers can currently expect appeals to be processed in approximately 60 days — which is the same approximate timeframe for processing of claims appeals for Commercial products. Appeals for Senior Products are taking longer, with an average processing timeframe of approximately 180 days. We recognize the importance of timely appeal resolution and are dedicated to further reducing these timeframes.
We encourage providers to allow for the full review timeframes noted above before contacting the Provider Service Center for a status update. Once the applicable timeframe has passed, providers may contact the Provider Service Center for additional information. If a request is made prior to the completion of the applicable review timeframe noted, updates may not be available or may be limited.
Additionally, please do not submit duplicate appeals, as this may further delay processing timelines.
For details on claims appeals, please refer to our online Provider Manuals and our Provider Claims Appeals flyer.
We appreciate your understanding and patience as we continue to make improvements.