5/10/2023
Prior to submitting a complaint or an appeal, take into consideration that some issues related to the managed healthcare industry are outside of the scope of the business of Midlands Choice. Complaints or appeals related to the following issues should be submitted directly to the payer for consideration:
- Non-covered charges
- Denied charges
- Eligibility and benefits
- Medical necessity
- Bundling of procedure codes
- Requests for a review or an appeal related to utilization management
Payer appeals should not be submitted to the Midlands Choice claim address. Refer to the provider remittance advice or the payer’s website for information on where to submit complaints or appeals.