Provider Manual

Claim Denials & Payment Disputes

Guidelines and forms to submit a provider appeal and access to the claim review form.

Provider Appeal Procedures

Request for Claim Review Form

Contract Rate, Payment Policy or Clinical Policy Claim Denials

Notification of Prior Authorization Claim Denial

Request to Review Duplicate Claim Denials

Claim Past Filing Time Limit Denial

Manual Sections

Member Information

Network Operations

Medical Management

Health Care Quality

Health New England Products and Benefits

Billing and Reimbursement

Payment Policies

Online Solutions