How to file claim reconsiderations and clinical appeals for Surest claims.

The Surest health plan uses the UnitedHealthcare network.

Review the details below for your specific situation of claim reconsideration, clinical appeal, or retrospective clinical review, or refer to your PRA. Providers must follow the processes outlined below.

Questions about notification requirements? Call the pre-certification line at 877-237-0006.

Please follow the applicable UHC network clinical notification requirements. Refer to the member ID card for the clinical phone number.

How to file a claim reconsideration.

Claim reconsiderations are for provider disputes of pricing/payment.

Submit claim reconsiderations through the UnitedHealthcare Provider Portal.

Mail:

UHSS

Attn: Claims

PO Box 30783

Salt Lake City, UT 84130

Fax:

866-427-7703

To expedite the claim, please send to the attention of the individual you talked with about this matter (if applicable).

Peer-to-peer review*

What it is: A discussion where a provider can learn more about a pre-service denial of coverage for inpatient/outpatient services and present previously unavailable clinical information to a UnitedHealthcare medical director.

When to do it: Although this varies by plan and/or state, most reviews need to be requested within 24 hours of coverage denial.

Timing: The review request time frame is dependent on case type and any applicable state guidelines. Inpatient cases must be submitted within 3 business days and outpatient cases within 21 calendar days from posted denial. To begin, complete the peer-to-peer scheduling request form; this takes about 5–10 minutes.

Please note: This review can be done prior to submitting an appeal.

Go to form

How to file a clinical appeal.

Providers can submit clinical appeals to dispute a medical necessity determination. You can only submit a clinical appeal if you’ve received a clinical denial following a medical necessity review. Please remember to attach all supporting materials to the appeal request, including member-specific treatment plans or clinical records (as detailed in the clinical denial letter).

Note: If services were rendered without prior authorization, see info within “How to initiate a retrospective clinical review.”

Mail:

Surest Appeals
PO Box 31270
Salt Lake City, UT 84131

Fax:

Urgent Appeal Fax Line: 1-866-748-7304
Non-Urgent Appeal Fax Line: 1-866-748-7820

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*Available for UnitedHealthcare-managed prior authorizations, not third-party vendors