Provider Appeals

All Provider (both contracted and non-contracted)

If you are submitting a corrected claim for adjudication, you must submit the corrected claim electronically with the appropriate resubmission code 7 and the original claim number referenced for physician claims & the correct type of bill XX7 for facility claims. Corrected claims are not accepted via email/fax. For additional information regarding PreferredOne'sAspirus payer ID & clearinghouse connections to submit claims electronically, please visit our EDI resources page here.

If you are responding to a PreferredOneAspirus request for additional information in order to continue to process a claim (i.e. – medical records, accident details, primary EOB data) those documents MUST be submitted to the department/fax that is indicated on the request letter from PreferredOneAspirus. If these documents are submitted elsewhere your claim issue may be delayed and/or denied.

If you are appealing a benefit determination or medical necessity determination, please call our Customer Service department at 763-847-4477 or 1-800-997-1750 1-866-631-5404 for assistance.

*Please note, all benefit determination or medical necessity determination appeals MUST go through Customer Service & will not be accepted via fax or email by the Coding, IHS or Network Management departments.

PLEASE NOTE THAT APPEALS SUBMITTED WITHOUT DOCUMENTATION ARE INELIGIBLE TO BE REVIEWED.

PreferredOneAspirus Contracted Providers

If you are appealing for one of the following reasons, please use this formform

  • timely filing denial
  • you do not feel that your contracted payment rate was applied correctly
  • you received a denial for a missed prior authorization
  • you received a denial code P60 on your PreferredOneAspirus claim remittance

*forms for these appeals can be submitted directly to your assigned Provider Relations representative either via email or fax; if you do not know who your provider relations representative is please contact providerreps@preferredone.com.

If you are appealing a coding denial or code-related edit, please use this formform.

*Instructions within this form indicate materials required to appeal along with the email address where appeals should be submitted.

PLEASE NOTE THAT APPEALS SUBMITTED WITHOUT DOCUMENTATION ARE INELIGIBLE TO BE REVIEWED.

Non-Contracted Providers

If you are appealing a coding denial or code-related edit, please use this formform.

*Instructions within this form indicate materials required to appeal along with the email address where appeals should be submitted.

PLEASE NOTE THAT APPEALS SUBMITTED WITHOUT DOCUMENTATION ARE INELIGIBLE TO BE REVIEWED.