Claim disputes and appeals
Medical necessity claim disputes for contracted providers
You can submit an appeal to request a review of a previous decision related to medical necessity, clinical guidelines or prior authorization and referral requirements.
HealthSpring offers participating providers one level of appeal for Medicare Part C claim disputes. A HealthSpring representative not involved with the initial decision will review your dispute.
Requesting an appeal
Complete the postservice appeal and claim dispute form and submit by fax or mail:
Fax
Participating provider appeals:
Mail
HealthSpring Appeals
PO Box 188085
Chattanooga, TN 37422
If you have questions on appealing or disputing a claim, call
Refer to our provider manual for more information and specific details on timely submission of provider appeals and supporting documentation requirements.
If you have requests related to claims reconsiderations, refer to the provider manual.
Claim appeals for noncontracted providers
You can submit an appeal if you disagree with a previous claim determination for items or services or a revised determination for items or services. A completed Waiver of Liability is required to process your appeal. The waiver must be signed by the provider and cannot be signed by a third-party billing agency.
A HealthSpring representative not involved with the initial decision will review your appeal.
Requesting an appeal
Complete the postservice appeal form and submit by fax or mail:
Fax
Standard medical appeals:
Mail
HealthSpring Appeals
PO Box 188081
Chattanooga, TN 37422
Coverage appeals
You can request an appeal of a previously denied authorization for services that haven’t been rendered.
A HealthSpring representative not involved with the initial decision will review your appeal.
Requesting an appeal
Complete the authorization appeal form and submit by fax or mail:
Fax
Standard medical appeals:
Expedited medical appeals:
Mail
HealthSpring Appeals
PO Box 188081
Chattanooga, TN 37422