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Dispute & Appeals

Information to guide you

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The dispute process made simple

The dispute process allows you to disagree with a claim or utilization review decision. Discover how and when to submit a dispute. Learn about the timeframe for appeals and reconsiderations. And find contact information for different issues.

Learn more about the dispute process
View our dispute process quick reference guide

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Medicare appeals

Learn about Medicare hospital discharge appeals, as well as
non-participating provider payment appeals.

Learn more about Medicare appeals

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Have more questions?

Read our FAQs. We have answers to many questions, including:

  • What is a dispute?
  • What is the procedure for disputing a claim decision?
  • What is a reconsideration?
  • What is an appeal?

See frequently asked questions

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State-specific information

We have state-specific information about disputes and appeals. We also have a list of state exceptions to our 180-day filing standard. Exceptions apply to members covered under fully insured plans.

View state exceptions to the filing standard

Now that’s innovation

Innovation Health is transforming the health care journey. Through innovative programs, coordinated care, and remarkable access, our health plans are personalized to fit our members’ needs. Discover how we are helping members achieve their health ambitions right in their community.

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Legal Notices & Privacy Policies

Health plans are offered and/or insured by Innovation Health Plan, Inc. (“Innovation Health”). Innovation Health® is the brand name used for products and services provided by Innovation Health Plan, Inc. Innovation Health Plan, Inc. is an affiliate of Aetna Life Insurance Company and its affiliates (Aetna). Aetna provides certain management services to Innovation Health. Aetna, CVS Pharmacy® and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health® family of companies.

This material is for information only and is not an offer to contract. An application must be completed to obtain coverage. Rates and benefits vary by location. Providers are independent contractors and are not agents of Innovation Health. Provider participation may change without notice.

Language Assistance Language assistance can be provided by calling the number on your member ID card. For additional language assistance: Español | 中文 | Tiếng Việt | 한국어 | Tagalog | Pусский | العربية | Kreyòl | Français | Polski | Português | Italiano | Deutsch | 日本語 | فارسی | Other Languages…