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Processes for post-service appeals and grievances

October 9, 2019

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).

NaviNet® is a registered trademark of NantHealth, an independent company.


This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
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