Provider Appeals

All Providers (Contracted and Non-contracted)

If you are submitting a corrected claim for adjudication, you must submit the corrected claim electronically with the appropriate resubmission code 7 and the original claim number referenced for physician claims & the correct type of bill XX7 for facility claims. Corrected claims are not accepted via email/fax. For additional information regarding Aspirus payer ID & clearinghouse connections to submit claims electronically, please visit our EDI Resources page.

If you are responding to a Aspirus request for additional information in order to continue to process a claim (i.e. – medical records, accident details, primary EOB data) those documents MUST be submitted to the department/fax that is indicated on the request letter from Aspirus. If these documents are submitted elsewhere your claim issue may be delayed and/or denied.

If you are appealing a benefit determination or medical necessity determination, call Customer Service at 1-866-631-5404 for assistance.

All benefit determination or medical necessity determination appeals MUST go through Customer Service & will not be accepted via fax or email by the Coding, IHS or Network Management departments. Appeals submitted without documentation are ineligible for review.

Aspirus Contracted Providers

Providers appealing for the following reasons should use the Claims Adjustment Request Form (PDF).

  • timely filing denial
  • you do not feel that your contracted payment rate was applied correctly
  • you received a denial for a missed prior authorization
  • you received a denial code P60 on your Aspirus claim remittance

Providers appealing a coding denial or code-related edit should use the Claims Coding Appeal Request Form (PDF).
PLEASE NOTE: Appeals submitted without documentation are ineligible for review.

Non-Contracted Providers

Non-Contracted Providers appealing a coding denial or code-related edit should use the Claims Coding Appeal Request Form (PDF).
PLEASE NOTE: Appeals submitted without documentation are ineligible for review.