Provider Appeals

Provider Appeals

Medicare Advantage Provider Dispute Process
Provider Dispute Resolution Procedure (PDRP) Form
Waiver of Liability
Appointment of Representative

If a provider has reasonable documentation (e.g. Medicare carrier remittance advice) indicating the payment amount received for a service (including the member cost sharing collected) is less than would have been received under Original Medicare for the service, you may appeal the payment amount.

Standard appeals of a denied claim may be submitted if a waiver of liability statement has been completed indicating the member will be held harmless regardless of the appeal outcome. Waiver of liability statements and Appeal letters should be sent to:

BlueCross and BlueShield of Tennessee
Attn: BlueAdvantage Operations Appeals / Grievance coordinator
1 Cameron Hill Circle, Suite 0039
Chattanooga, TN 37402-0039

Beneficiary Appeals and Grievance Requirements:

  • Members who disagree with our decision regarding the handling of a claim, or denial of a service or prescription drug, have the right to file an appeal. If a review of the claim does not result in an overturn of the original decision, the appeal will be reviewed by an independent review organization selected by CMS.
  • Members may assign someone, such as a relative, advocate or physician, to act as their representative and file appeal on their behalf.
  • Expedited determinations can be requested by the member (including his /her authorized representative) or a physician.

 

Page Modified:May 21, 2012