Resources

Blue Cross and Blue Shield of Alabama has an established appeals process for providers. The following documentation provides guidance regarding the process for appeals. 

Provider Post-Service Appeal Form: Use this form for all of your appeal requests including claims reconsideration, reimbursement and medical necessity. Be sure to provide all of the required information as indicated, including a provider signature. 

Providers are required to file all post-service appeals to their local Blue Cross Plan regardless of the member's Home Plan. For example, if an Alabama physician provides services to a member with Blue Cross and Blue Shield of Kansas coverage and a post-service appeal is needed, the physician should fill out the form above and submit it to Blue Cross and Blue Shield of Alabama.

Attach any additional information and/or medical records at the time of filing the appeal for consideration. Preservice and concurrent appeals should continue to be submitted to the member’s Home Plan.

Appeals Form Submission Guidelines

• Use the new form for all provider appeals.
• Complete all fields in the form.
• Select only one appeal reason.
• Confirm there is a provider’s signature on all submitted forms.
• Include additional supporting documentation if indicated for the appeal reason selected.

Note: You can call Provider Customer Service after 15 business days to check that the form has been received. If you have not received a response to your submitted appeal after 30 days, you can call to verify the status of your appeal. If a Provider Customer Service representative says your appeal is not on file, it is likely because of an issue with one or more of the guidelines listed above.

For more information about the appeals process, view the Q&A documents listed below:

• Preservice Q&A
• Post-Service Q&A