NETWORK MANAGEMENT
Provider Appeal Process Update
With the sunsetting of the PreferredOne business, PreferredOne Provider Relations will no longer be able to accept paper appeals for the following appeal types beginning on 1/1/2024:
- timely filing denial
- you do not feel that your contracted payment rate was applied correctly
- you received a denial for a missed prior authorization
- you received a denial code P60 on your PreferredOne claim remittance
Appeals related to these types of denials that are submitted on 1/1/2024 or after must be emailed to providerreps@preferredone.com. Paper appeals will no longer be accepted & will be unable to be returned or responded to after that date.
For all other types of appeals including coding appeals, benefit determination appeals, & medical necessity appeals, please see our provider website here (https://www.preferredone.com/providers/provider-appeals.aspx) for the process to submit those types of appeals. As a reminder these appeals can be submitted as follows:
-
coding appeals –
- please email appeals to appeals@preferredone.com using the coding appeal form found on our website linked above
-
benefit determination appeals & medical necessity appeals (not missed prior authorization appeals) –
- these types of appeals must always be initiated by phoning our Customer Service department at 763-847-4477 or 1-800-997-1750
***If you are not a contracted provider with PreferredOne, please contact Customer Service for questions regarding your appeal process.