Summer 2009

Provider appeal form streamlined

Blue Cross and Blue Shield of Florida (BCBSF) has made it easier for you to do business with us by combining all our provider appeal forms into one comprehensive appeal form. You no longer need to submit various forms for different types of provider appeals. This new Provider Appeal Form is for use by all physicians and providers who bill on a CMS-1500 or UB-04 claim form.

Provider appeals are requests for reconsideration of how a claim processed, paid or denied. There are four different types of appeals:

• Utilization Management

• Adverse Determination

• Coding and Payment Rule

• All Other

Regardless of the type of appeal, you only need to use the Provider Appeal Form. To submit an appeal, simply complete the new Provider Appeal Form, available on the BCBSF website, www.bcbsfl.com; click Physicians & Providers; then under the Tools & Resources section click on Forms. Based on your appeal type, follow the appropriate instructions included on the form and mail to the applicable address.

The new form is for provider appeals only. You should continue to use the Provider Claim Inquiry Form for submitting inquiries (corrected claims, late charges, medical records, etc.).