How to File an Appeal. If you disagree with either a pre-service request for Benefits determination, post-service claim determination or a rescission of coverage determination, you can contact us in writing to formally request an appeal. • Your request for an appeal should include: • The patient's name and the identification number from the ID card. • The date(s) of medical service(s). • The provider's name. • The reason you believe the claim should be paid. • Any documentation or other written information to support your request for claim payment. Your first appeal request must be submitted to us within 180 days after you receive the denial of a pre- service request for Benefits or the claim denial.
How to File an Appeal. You can discuss your wish to appeal with a staff member or contracted provider of your choice. Give complete information so appropriate staff can initiate the appeal process in a timely manner. You may designate a representative to file an appeal on your behalf. PACE CNY staff can be reached by calling: If these times are not convenient, on-call staff can be reached by calling the same numbers after hours including holidays and weekends. You may also file an appeal by writing to:
How to File an Appeal. If you wish to file a formal appeal, you must write to Blue Cross and Blue Shield of South Carolina, Member Services Center, P.O. Box 100300, Columbia, SC 29202. The appeal must state that you are requesting a formal appeal and include all pertinent information regarding the claim in question that you wish to be considered in the appeal. Claims and appeals for services and supplies which are specifically excluded in the Policy are not eligible for external review. The following guidelines apply for each type of claim (including the appropriate claim with regard to a Concurrent Care decision), unless both parties agree to an extension:
