How to file claim reconsiderations and clinical appeals for Surest claims.

The Surest health plan uses the UnitedHealthcare network.

Review the details below for your specific situation of claim reconsideration, clinical appeal, or retrospective clinical review, or refer to your PRA. Providers must follow the processes outlined below.

Questions about notification requirements? Call the pre-certification line at 877-237-0006.

Please follow the applicable UHC network clinical notification requirements. Refer to the member ID card for the clinical phone number.

How to file a claim reconsideration.

Claim reconsiderations are for provider disputes of pricing/payment.

Submit claim reconsiderations through the UnitedHealthcare Provider Portal.

Mail:

UHSS

Attn: Claims

PO Box 30783

Salt Lake City, UT 84130

Fax:

866-427-7703

To expedite the claim, please send to the attention of the individual you talked with about this matter (if applicable).

How to file a clinical appeal.

Providers can submit clinical appeals to dispute a medical necessity determination. You can only submit a clinical appeal if you’ve received a clinical denial following a medical necessity review. Please remember to attach all supporting materials to the appeal request, including member-specific treatment plans or clinical records (as detailed in the clinical denial letter).

Note: If services were rendered without prior authorization, see info within “How to initiate a retrospective clinical review.”

Mail:

Surest Appeals
PO Box 31270
Salt Lake City, UT 84131

Fax:

Urgent Appeal Fax Line: 1-866-748-7304
Non-Urgent Appeal Fax Line: 1-866-748-7820

How to initiate a retrospective clinical review.

In certain circumstances, Surest allows providers to initiate retrospective reviews (post-service) for services requiring prior authorization.

• If you have yet to submit the claim: You can initiate a retrospective review within 180 days from the date of service. Call 877-237-0006 to initiate the review.
• If the claim was submitted — and denied — due to no prior authorization: You can initiate a retrospective review within 180 days from the date of the claim denial. Call 877-237-0006 to initiate the review.

Do not send any clinical documentation to claims reconsideration or the clinical appeals team.

Any correspondence directed to the wrong address/fax could be returned to you, which may result in delayed reimbursement.

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