dental claim reconsideration letter template

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A commercial dental reconsideration follows the payer's own published process, and the windows differ sharply. Cigna publishes 180 calendar days from the initial payment or denial notice, extended to 365 calendar days for providers in California, with mailed appeals to the National Appeals Unit at PO Box 188011, Chattanooga TN 37422, or PO Box 188062 for GWH-Cigna and G cards, and arbitration within one year of the final internal decision letter. Aetna runs a two-step ladder: reconsideration within 180 calendar days of the initial claim decision, then appeal within 60 calendar days of the reconsideration decision, extended to 180 days where the issue is medical need or experimental and investigational criteria, filed through Availity or on form GR-69140 to the Provider Resolution Team at PO Box 14020, Lexington KY 40512. Delta Dental publishes a claim adjustment within 90 days, a decision in 30 days, then a provider dispute only after that denial with a written response in 45 working days and a 365-day outer bound, mailed to P.O. Box 997330, Sacramento CA 95899-7330. MetLife's Federal Dental Plan takes a written request with no form, 180 days from receipt of the decision, to P.O. Box 14589, Lexington KY 40512. United Concordia's New Jersey commercial route allows 180 calendar days on the Health Care Provider Application to Appeal a Claims Determination, to PO Box 69420 Harrisburg PA. Guardian takes a written letter of appeal - it publishes no appeal form - and commits to a decision within 60 days, 45 for disability appeals, or less where state law requires. Every one of these payers states that the provider agreement or applicable law supersedes the published guide, so the contract number is the one that controls.