CLAIM APPEALS & ADJUSTMENTS
A claim adjustment should be submitted if you notice an error on your claim once it has already been processed for payment. The following fields can be corrected:
- Charge Amount
- Procedure Code
Along with a copy of the corrected claim, the office should submit either a cover sheet or the Claim Adjustment form to describe what correction was made. These documents must be faxed to the Claim Services department at: 517-394-4590. Failure to follow this step could result in the corrected claim denying as a duplicate submission. Adjustments concerning denied claims must be submitted within 12 months of the original denial date.
If you disagree with the HP's determination of a claim payment decision, providers and members may submit an appeal. The CHP has two levels of claim appeals:
For more information and complete submission instructions click on the "Electronic Claim" link on the quick links menu.
Claim Reconsideration Review: This appeal can be submitted either verbally or in writing. Requests for timely filing must be received within 16 months from the date of service, provided the claim was originally submitted within 12 months of the date of
service. Review requests submitted after the time frame has expired shall not be reviewed.
Requests for reasons other than timely filing must be received by the HP within 12 months from the date the claim was denied. Review requests submitted after the time frame has expired shall not be reviewed.
Level 1 Appeal: This appeal must be submitted in writing within 60 days after the claim reconsideration review decision. The appeal must include the reason for request, name, address, and telephone number of the person responsible for filing the appeal, copy of the claim, and any documentation to support the appeal.
Appeals should be submitted to:
P.O. Box 30125
Lansing, MI 48909