![]() Please note: Network providers do not have appeal rights and must use the payment dispute process outlined above to address any claim payment issues. If your appeal is approved, your payment will appear on the Explanation of Payment (EOP).Ĭlaim appeals will be resolved within 60 calendar days from the date of receipt. You will receive notification in writing if the appeal is denied. If the appeal is not submitted in the required time frame, the claim will not be reconsidered, and the appeal will be denied. If you do not agree with a denial on a processed claim, you have 60 calendar days from the date of service or discharge, unless otherwise specified in your contract, to submit an appeal. Appeals must be submitted within 60 days of the date of the denial. If the decision is to uphold the original claim adjudication and you are a non-participating provider, you may appeal the decision. Claim disputes can be submitted to CareSource through the following methods:ĬareSource will render a decision within 30 calendar days of receipt. Incomplete requests will be returned with no action taken.
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