Adverse Benefit Determination
Adverse benefit determinations encompass various actions, such as denial, reduction or limitation of services or payments, that providers need to be aware of when delivering and managing member care.
Standard Appeals
If you, as a provider, disagree with a decision regarding Passport benefits for your member, you can submit an appeal for review. During the appeal process, Passport will notify you of your rights, qualified professionals will review your case and Passport will communicate the outcome, including further options if they uphold the denial.
Expedited Appeals
An expedited appeal asks Passport to quickly review an adverse benefit decision involving hospital admission, continued stay or other health services if waiting for a standard appeal could seriously risk the member's life, health or recovery.
Next Level Rights
Providers may request external independent third party review.
Provider Claim Disputes
Providers can request a review of previously processed claims, following Passport’s established redetermination procedures. This process ensures Passport handles claims disputes and adjustments promptly and transparently.
For more information, see our Provider Dispute Policies