​We continue to receive a high volume of claim review requests inappropriately sent to the member appeals fax number. Misdirected requests can cause delays in processing.

Do NOT use the appeals fax number to submit medical records not related to a member appeal or to request a status of a Claim Investigation.

Providers and their third-party vendors must adhere to the proper submission channel for claim review requests.

If you have a claims-related issue, please use the Practice Management application on the Provi​der Engagement, Analytics & Reporting (PEAR) portal to submit a Claim Investigation request via the Claim Search transaction. Review the Claim Search & Investigation user guide in the PEAR Help Center for assistance.

As a reminder, the member appeals fax number should only be used when you are submitting an appeal on the member's behalf.

Examples include:

• Provider appeals on behalf of the member with a valid member consent form.
• Expedited preservice appeals on behalf of the member.

For all other appeals, follow the appeal submission procedures outlined in the Appeals section of the Provider Manual for New Jersey or Pennsylvania or the Clinical Services – Utilization Management section of the Hospital Manual for New Jersey.

Thank you in advance for ensuring the appropriate channel is used when submitting future appeal requests.

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