Dispute Resolution Process for Medical Necessity Disputes

This review process seeks to resolve disputes concerning services that are determined to be non-covered due to not being medically necessary, experimental or investigational in nature. The physician must exhaust the post service internal appeal process to qualify for the external review process. The physician may submit a written request to IMEDECS within 60 days from the date of the internal post service appeal non-coverage decision. Physicians seeking external review shall pay a filing fee of $50 if the amount in dispute is $1,000 or less or $250 if the amount in dispute exceeds $1,000. Payment must be submitted with the review request.

Providers can submit a medical necessity dispute resolution by submitting it to the address or fax number below:

Attention: IMEDECS

External BCBSAL

6802 Paragon Place, Suite 440

Richmond, VA 23230

Telephone: 215-855-4633, ext. 324
Fax: 215-855-5318

Providers may also access the Blue Cross and Blue Shield of Alabama Provider Appeals section on our website for additional information on these type disputes.