Denial Resolution Search

Providers receive results of reviews on their Electronic Remittance Advice (ERA). Search by selecting categories Claim Adjustment Reason Codes (CARC) or Remittance Advice Remark Codes (RARC) and the corresponding code below.

Reconsiderations

If a provider disagrees with a payment determination and a claim correction is not the next step, request a Reconsideration using the Appeal form. Reconsideration timelines for request align with the respective appeal timelines for commercial and Medicaid Expansion.

A reconsideration is not an appeal as it’s a payment dispute and not an adverse benefit determination; it does not use the member’s appeal rights. A reconsideration of a payment determination is a provider right only. When completing the appeal form, select Provider on behalf of self. 

Providers will receive a reconsideration notification within 45 days of receipt of the request. If a provider disagrees with the determination, they will have the option of requesting a second reconsideration within 45 days. Providers will receive a reconsideration notification of their subsequent request within 45 days of receipt of the request.