INET Claims Appeals/Reconsiderations
*Disclaimer: HCFA-1500 OR UB-04 ORIGINAL OR CORRECTED CLAIM FORMS ARE NOT ACCEPTED THROUGH THIS PORTAL, PLEASE SEE NEW CLAIM FAQ ON INTEGRANET HOME PAGE
*Disclaimer: All Submission must include an attached Reconsideration/Appeal request form. Request submitted without a Reconsideration/Appeal form will be considered an invalid submission. Non-Contracted Providers must include a completed Waiver of liability form of Reconsideration/Appeal request. https://www.cms.gov/medicare/appeals-and-grievances/mmcag/downloads/model-waiver-of-liability_feb2019v508.zip
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Reconsideration
Level 1 Appeal
Level 2 Appeal
Anthem Priority Requests (Anthem/Amerigroup Reps only)
Health Plan
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Amerigroup
SCAN
Verda
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