Level of Care Claims Processing Reminder

Providers,

Please note that high-dollar inpatient claims for the MMP and Medicaid line of business will be priced at the authorized level of care, unless Gold Carded.

If you disagree with the pricing of your claim, please submit a formal appeal to our Grievance and Appeals (G&A) team for review. This process may potentially update your authorization to reflect the billed level of care, if approved. Once approved, your claim can be sent to be reprocessed and paid per the new authorized levels of care.

If you have any questions, please reach out to our Provider Relations team through the Provider Relations Inquiry Form.