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Provider Appeals

Provider administrative (or medical) appeals

The purpose of the AmeriHealth Caritas Iowa provider appeals process is to address medical necessity determinations regarding health care services. This process is not intended to address denied claims or other issues.

Providers can call the Peer-to-Peer telephone line at 1-844-412-7887 to discuss a medical necessity determination with a physician in the AmeriHealth Caritas Iowa Medical Management department.

How to file an appeal

Providers must call within two business days of notification of the determination or prior to the member's discharge from a facility when the determination applies to an inpatient case. A provider requesting an administrative or medical appeal, for the reversal of a medical denial, may also submit an appeal in writing to:

AmeriHealth Caritas Iowa
Attn: Provider Appeals Department
P.O. Box 7128
London, KY 40742

Filing an appeal on behalf of a member

A provider may also file an appeal on a member’s behalf, with the member's written consent. To file an appeal as an authorized representative on behalf of a member, a provider may call the Provider Appeals telephone line at 1-844-214-2473.