As a reminder, Independence has streamlined the process for post-service
professional appeals and enhanced access to the provider grievance process.
Below is a summary of the procedures.
Billing disputes
There are two levels of internal review for professional providers. All
first-level billing disputes must be received within 180 days of receipt of
your Provider Explanation of Benefits (EOB). If a provider disputes the
first-level billing dispute determination, he or she may then submit a
second-level billing dispute by sending a written request within 60 days of
receipt of the decision of the first-level billing dispute.
To facilitate a first- or second-level billing dispute review, submit to:
Provider Billing Dispute
P.O. Box 7930
Philadelphia, PA 19101-7930
Provider grievances
There is a one-level external review performed by a clinically matched
specialist for professional providers. All grievances must be filed within 180
days of receiving the Provider EOB. Independence reserves the right to conduct
a preliminary internal assessment. Appeals not overturned during the
original assessment will automatically be forwarded for an external,
matched-specialty review.
To facilitate a grievance review, submit to:
Provider Grievances
P.O. Box 7930
Philadelphia, PA 19101-7930
Learn more
For a complete outline of the post-service professional provider appeals and
grievances processes, please review the Appeals section of the Provider
Manual for Participating Professional Providers (Provider
Manual). The Provider Manual is available on the
NaviNet® web portal (NaviNet Open) in the Current Publications
section of Independence’s NaviNet Open Plan Central page.
If you have any questions, please call Customer Service at
1-800-ASK-BLUE (1-800-275-2583).
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