Provider Appeals for Experimental/Investigational or Not Medically Necessary Services

<p>Providers have the right to appeal a claim, which has been denied based on lack of medical necessity or service being experimental/investigational. If a provider is submitting a new diagnosis, a corrected claim or requesting review of the denial, this will be considered a first level or initial appeal. Providers should follow the Initial Appeal and Final Appeal process, when applicable, as outlined within the annual Policies & Procedures document.</p> <p>If you have any questions regarding this newsletter, please contact your<strong> </strong><a href="/providers/institutional/contact-us">BCBSKS Institutional Relations provider consultant</a>.</p>