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In accordance with the provisions of Health Claims Authorization,
Processing, and Payment Act (HCAPPA), a health care provider may initiate a
first-level provider appeal. For AmeriHealth New Jersey commercial members, the
appeal must be received on or before the 90th calendar day following the
receipt of our claims determination. Submit your appeal request using the Health Care Provider Application to Appeal a
Claims Determination form, as specified by the New Jersey Department of
Banking and Insurance (DOBI).
Along with the DOBI form, the provider should submit any additional relevant
information in support of the appeal.
Please send the claim form and any supporting documentation to:
- AmeriHealth New Jersey Provider Claim
Appeals Unit
- 259 Prospect Plains Road
- Building
M
- Cranbury, NJ 08512
You may also
email
the form or fax the form to
609-662-2480.
Please contact your Network Coordinator or Hospital/Ancillary Services
Coordinator with any questions.
]