Frequently Asked Questions: Appeals

What steps must a physician take to appeal a processed claim?

The HMSA appeals process for physicians is explained in the Participating Physician Agreement and is also described in Appealing Processed Claims.

What steps must a physician take to appeal the denial of a precertification request?

The HMSA appeals process for physicians wishing to appeal the denial of a precertification is described in Appealing a Pre-Certification Denial.

Note: A facility may not appeal the denial of a precertification. Such an appeal must be made by the member or the member’s physician.

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