If a provider does not agree with the outcome of a claim determination, the provider may challenge the decision by using the claim payment appeals process. If there is a full or partial claim rejection or the payment is not the amount expected, submit a claims appeal. The appeal must be received by UniCare Health Plan of West Virginia, Inc. (UniCare) within 365 days from the date on the notice of the letter advising of the action.
UniCare uses Availity*, a secure, full-service web portal that offers a claims clearinghouse and real-time transactions at no charge to health care professionals. Use Availity to submit claims, check the status of claims, appeal a claim decision and much more.