What steps must a physician take to appeal a processed claim?
The HMSA appeals process for physicians is explained in the Participating Physician Agreement and is also described in Appealing Processed Claims.
What steps must a physician take to appeal the denial of a precertification request?
The HMSA appeals process for physicians wishing to appeal the denial of a precertification is described in Appealing a Pre-Certification Denial.
Note: A facility may not appeal the denial of a precertification. Such an appeal must be made by the member or the member’s physician.