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Provider Payment Appeal Process and Timing Requirements
Providers may appeal post-service payment denials to RADCON. The RADCON Appeals policy is limited to appeals of post-service payment. RADCON does not engage in appeals of medical necessity or clinical appeals and RADCON does not address member appeals. Appeals outside the scope of the RADCON appeals process are forwarded to the member health plan for resolution.
Appeal Category
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Appeal Process |
| Level 1 Administrative Appeals |
- Providers may appeal post-service payment denials in writing on letterhead within 180 calendar days of the initial RADCON EOP (payment coorespondence)
- All appeals are considered standard appeals
- Appeal determinations are made based on information supplied by the provider or information applied by RADCON during payment processing. RADCON does not grant appeal extensions to enable providers to supply supplemental information
- Reviews are conducted by the RADCON Quality Improvement Committee and RADCON Staff who are not responsible for claims payment on a day-to day basis
- A written response outlining the appeal determination is supplied to the provider
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| Arbitration |
- RADCON forwards the request for arbitration and all related documentation to the health plan within 24 hours of recipt of the request for arbitration
- Member health plan conducts all correspondence related to arbitration request for final resolution
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For additional questions, please call 1-800-404-8064.
Committed to Excellence in Radiology |
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