Appeal process 

What is an appeal?

An appeal is a written request by you or your authorized representative (example: your provider) to dispute the adverse decision related to your coverage. Before submitting an appeal, contact the SmartHealth Customer Service team at 888-492-6811 to review any adverse coverage determinations. This team may be able to resolve your issue quickly outside of the formal appeal process. If not, they will advise you of your appeal rights.

To avoid having to submit an appeal, ensure you have a prior authorization or benefit elevation, before services are rendered. Find services that require an authorization and benefit elevation requirements


Appeal Process Information

Post service and second level appeal request form