With rosa sanchez pdr coordinator Provider Claims Appeal Webinar With rosa sanchez pdr coordinator

How to update your profile Log into Connect From the home page click on the user icon and select manage profile

3. Update your user information and click save at the bottom of the page

Updating your Profile It is very important to keep your contact information in your profile update to date. The address information contained in your profile is used when mailing the acknowledgement and resolution letters.

The Do’s and Don’ts of claim dispute submission 1. Do not submit medical necessity appeals 2. Do not submit claim adjustments requests or corrected claims 3. Do not submit claims status checks 4. Do not submit second level appeals 1. Include attachments 2. Provide A clear and concise reason for the dispute 3. Verify your address and phone number in your user profile 4. Call or email us if you have questions Do Don’t

Here you can select new to start entering a new Appeal Corrected Claims Medical Necessity Second level Appeals Request for Medical Records or Request for EOB’s are not Valid Appeals – when submitting Medical Records or EOB’s please send to the Claims department with a copy of 1500 Form.

Click on Guidelines to view CHCN guidelines.

Select the Claim which you will be Appealing from the list, Press select to continue.

Select line Item that you will be Appealing in this example below there is a line Item VEIN this would be the one to select.

This is an example of a dispute reason below and how to attach documents to the appeal. Attaching documents is a requirement your appeal won’t be complete if you don’t attach supporting document’s.

Here you can see all the Open, Close, Resolved, and Upheld cases select one and you will be able to print out your letters and see dispute details.

Submitting your appeal through the Connect Portal, your appeal will be acknowledge within 2 working days instead of 15 working days, and you can print it out any time.

You will still receive a hard copy in the Mail

From the claims application you will be able to open an Appeal, check status and click on the claim you want to appeal.

This is an example of a dispute reason below and how to attach documents to the appeal. Attaching documents is a requirement your appeal won’t be complete if you don’t attach supporting document’s.

Questions? Not all claim disputes are the same. If you have a question regarding the validity of the dispute or if submitting the dispute via Connect’s dispute app is appropriate you can reach us by phone or email at: By Phone: 510-297-0480 By Email: portalsupport@chcnetwork.org

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