Claims Dispute Form

Meridian Claim Dispute Instructions

Appeals can be submitted to the Health plan for two main types of issues:

The provider disagrees with a determination made by Meridian. In this case, the provider should send additional information (such as medical records) that support the provider’s position.
The provider is requesting an exception to a Meridian policy, such as prior authorization requirements. In this case, the provider must give an explanation of the circumstances and why the provider feels an exception is warranted in that specific case.

The above mentioned instances should not be submitted through the Claims Dispute Portal. All appeal requests should still be submitted to the appropriate address listed below:

Michigan

Health Plan & Correspondence Type

Date of Service

Mailing Address

MI Claim Appeals (Medical) (Medical necessity, authorization denials, and benefits exhausted)

On or before

March 31, 2022

Meridian

ATTN: Appeals Department

PO Box 44287

Detroit, MI 48244

On or after

April 1, 2022

Meridian

ATTN: Appeals Department

PO Box 8080

Farmington, MO

63640-8080

Illinois

Meridian Health

Attn: Appeals Department

PO Box 44287

Detroit, MI 48244

Fax Number: 312-508-7255

For additional information and requirements regarding post authorization and non-post authorization appeals, provider claim disputes or claim processing guidelines, please refer to the MI Provider Manual or IL Provider Manual.

You may view Claim Detail status and Claim Dispute status on our secure Provider Portal.

Attention Michigan Providers:

Effective April 1, 2022, all claim disputes for a date of service on or after April 1, 2022, should be submitted via mail or the new secure portal using the guidelines and mailing addresses below.

Health Plan & Correspondence Type

Date of Service

Mailing Address

MI Claim Payment Disputes

(Related to untimely fililng, incidental procedure, unlisted procedure code)

On or before

March 31, 2022

Meridian

ATTN: Claims Department

1 Campus Martius, Suite 710

Detroit, MI 48226

On or after

April 1, 2022

Meridian

ATTN: Claims Department

PO Box 8080

Farmington, MO

63640-8080

Attention Illinois Providers:

The dispute form can be used to dispute a professional or institutional claim with a date of service on or before 6/30/2021. Any dispute for a claim with a date of service 7/1/2021 or after should utilize the Illinois Meridian Provider Portal.　

All pharmacy issues should continue to use this form by selecting the Pharmacy Claim option above.

Illinois Provider's Current Projects and Resolution Timeframes

Prior to submitting a claim dispute, please check the status of an existing project via the Global Project Tracker or the Fee Schedule Load Timelines to confirm whether your dispute is already in process.

If you have a claim that should be included in one of the completed claim projects (which you believe denied incorrectly) and it has not yet been adjusted, please continue to use the form below to submit a claim dispute.

Please complete this electronic form and attach any supporting documentation.

All Answers are Required to Proceed

1. Have you received a payment remittance (paper or electronic) for this claim? Yes No

Mandatory Fields

NPI (National Provider Identifier)
Tax ID
Patient Name (Last Name, First Name)
Meridian ID
Billed Amount (no zero amount accepted)
Expected Payment Amount (Mandatory when Underpayment or Overpayment Claim Category is selected. No zero amount accepted.)
DOS (mm/dd/yyyy)
Other/response Reason (free text field – usually populated with proc code and reason)
Authorization Number (Mandatory when Underpayment Claim Category is selected. “NA” is acceptable, when applicable.)

All other fields will be optional: .

Facility or Provider Name
DOB
Status
Claim Number
Check Number

Tax ID/NPI/facility and Provider name are expected to be the same value for each row.
Max entry rows: 100
Must use the .csv file template

Attention

Meridian/MeridianRx Dispute Form

Select Dispute Type:

Non-Claims Dispute Form

Meridian Claim Dispute Instructions

Michigan

Health Plan & Correspondence Type

Date of Service

Mailing Address

Illinois

Health Plan & Correspondence Type

Date of Service

Mailing Address

Attention Illinois Providers:

Section 1: Claims Dispute

Section 2: Category of Claim Dispute

Explanation: