Effective March 1, 2023, all post-service provider appeals must be submitted via the Appeals Application on Availity Essentials.
The Appeals Application:
- Streamlines the appeals process by making it easy to submit appeals directly from the Claim Status screen
- Gathers all required information about the claim being disputed
- Prevents duplicate appeal submissions
The Appeals dashboard shows the status and history of submitted appeals, eliminating the need to contact us for status information. For the Appeals Application:
- The maximum number of files to upload is 10.
- Files must be larger than 3 KB.
- Maximum individual file size is 60 MB with a total of 150 MB across all files.
- Supported file types include: .csv, .doc, .docx, .gif, .html, .jpg, .jpeg, .msg, .pdf, .png, .ppt, .pptx, .rtf, .tif, .tiff, .txt, .xls, and xlsx.
Note: The only disputes and appeals that should not be submitted via Availity Essentials are:
- Pricing disputes, which are not appeals and are subject to a separate pricing dispute process
- Disputes that meet our Extenuating Circumstances exception criteria which must be submitted via fax
- Appeals that Availity cannot process because of file size limits (see above), which may be submitted via secure file transfer protocol (SFTP)
Access the application from Availity Essentials: Claims & Payments>Appeals. If you do not have access to the application, contact your Availity Essentials administrator and request the Claim Status role.
Appeals can be initiated from the Claim Status screen by selecting Dispute Claim.
View the training options available by clicking the Help & Training link in the Availity Essentials menu. View user guides on Availity Essentials: Help & Training>Find Help>Appeals. A recorded training demonstration is also available by searching for Appeals: Help & Training>Get Trained.
If you receive one of the following messages when trying to dispute a claim using the Appeals application, review the explanation for alternative options for submitting your dispute.