Please remember that the Grievance & Appeals Unit (GAU) only reviews appeals and does not process claims adjustments. If you are sending in a claim retraction, a claim correction, medical records, or anything listed on the Physician/Provider Claim Adjustment Request Form, that form must be mailed to the claims department at the address on the bottom of the form. All appeals should be submitted on the Physician/Provider Appeal Request Form.

Here are a few helpful tips to ensure you are sending your items to the correct department.

• If your claim is denied for timely filing, due to a retraction from another plan within 180 days of their retraction, you would need to submit the following paperwork for processing:

1. Physician/Provider Claim Adjustment Request Form
2. Copy of the other plan’s retracted Remittance Advice (RA) showing the complete retraction and the date of the RA. Please note: The claim cannot be retracted with a run date of when the RA was run by your office. The RA must include the other plan’s adjudication date.
3. Mail the Physician/Provider Claim Adjustment Request Form to the claims department at the address on the bottom of the form.
    

• If all the information was originally submitted on/with your claim, log in to your bcbsri.com account to find why your documents were not reviewed for accurate processing.
   
• If attachments have to be submitted to your claim, you will need to submit a paper claim, the Physician/Provider Claim Adjustment Request Form, and any required documentation. Mail those documents to the claims team at the address on the bottom of the Physician/Provider Claim Adjustment Request Form.
   
  GAU will work with the Provider Relations Team to educate any offices that are submitting claims adjustments incorrectly to GAU. If you have any questions about which form to use, please contact Provider Relations at ProviderRelations@bcbsri.org.