How to file a redetermination
If your claim was denied or you’re unhappy with your reimbursement, you may be able to have your claim reprocessed. Currently, we allow redeterminations to be filed for claims based on:
- Filing limits
- Claim check or code editing
- Contracted rate or payment policy
- Coordination of Benefits (COB)
- Data entry error
- Overpayment or underpayment
To file a redetermination , you must:
If there are multiple claims in question, you may provide an Excel spreadsheet that contains the additional information. Attach spreadsheet to a copy of the request form.
Mail your redetermination or request for adjustment to: Scott and White Health Plan ATTN: Claims Review Dept. P.O. Box 21800 Eagan, MN 55121-0800
The provider redetermination time limit for receipt of redetermination request is calculated from the date of original denial or Explanation of Payment (EOP). The Provider Claim Retedermination Request Form is processed within 30 days of receipt. To appeal RightCare Medicaid claims, visit RightCare.