Claims Appeals Procedures

All claims appeals must be submitted in writing within 90 business days from the date of the explanation of benefits. The appeal must outline reasons for the claim appeal with all necessary documentation including a copy of the claim and the EOB. Providers will receive a decision within 30 calendar days of receipt of the request.

If a provider is not satisfied with the decision of the first-level appeal because the decision of the claim was upheld, a second-level appeal can be submitted. Second-level appeals must be received within 30 calendar days of the date of the first-level appeal decision. The second-level appeal is the final level of appeal. Providers will receive a response within 30 calendar days of the receipt of the second-level appeal.

Claim Appeals should be sent in writing to:

MedStar Family Choice
P.O. Box 43730
Baltimore, MD 21236
ATTN: Claim Appeals Department

For a status on a claims appeal, please call our Claims Department at 800-261-3371.

Tips:

• Do not send in late appeals as they will not be considered.

• Providers with corrected claims should send these to our claims address for processing; appeals are for claims denied as originally submitted.