Is Healthnet Federal Services Still Working With Tricare

Claim Appeals

Only charges denied because the service is not covered by TRICARE or not medically necessary may be appealed. Your TRICARE Explanation of Benefits (EOB) or provider remittance will indicate if a denied charge is appealable. If the denial note does non betoken the charge can exist appealed, you may request a claim review instead of an appeal.

Note: Only Point of Service (POS) charges for emergency intendance can exist appealed. Visit our Disputing Point of Service Charges page to review other scenarios for disputing POS charges.

Who can appeal a denied claim?

TRICARE casher (or parent of a pocket-sized),
Legal guardian of the beneficiary,
A not-network provider (if he or she performed the service and accepted assignment on the claim),
A network provider (if appealing a claim on his/her ain behalf and the denied merits is appealable per the remittance observe) (Annotation: Network providers cannot neb patients for non-covered services or services denied as not medically necessary.),
Legally appointed representatives (appeals submitted by anyone other than the to a higher place will not be accepted unless he or she has been appointed as a representative past power of attorney or by submitting an Appointment of Representative for an Entreatment form), or
An attorney, if acting on behalf of an advisable highly-seasoned party.

How exercise you submit a claim entreatment?

A claim appeal must be filed in writing within 90 days of the date on the EOB or provider remittance. Y'all may employ the online appeal submission class below or submit an appeal letter via mail or fax.

Online option. Complete our online entreatment grade. You will be able to print a preview of your appeal before it is submitted and a copy of the submitted entreatment with a tracking number.

Postal service/fax option. Mail or fax the written claims entreatment and supporting documentation. At that place is no specific appeal form required. Be sure to include the following:

the patient's name, accost, telephone number and sponsor's Social Security number (required)
printed name of the person submitting the appeal and the human relationship to the patient (required)
the reason y'all are disputing the denial (required)
a copy of the EOB or provider remittance (not required but recommended)
additional documents supporting the appeal (not required simply recommended)

Health Cyberspace Federal Services, LLC
TRICARE Claim Appeals
PO Box 8008
Virginia Beach, VA 23450-8008
Fax: 1-844-802-2527

Exist certain to send supporting documentation within x days from submission via fax (or postal mail service if sending color photos).

What is the processing time for claim appeal?

A reply from Health Net Federal Services, LLC (HNFS) will usually be sent within thirty days of receiving the appeal. If the deprival is upheld or partially upheld, and next level appeal rights are available, they volition be given in the appeal decision letter of the alphabet. If the denial is overturned the claims volition be reprocessed inside 21 days of the appeal decision.