Physicians may request a re-opening (peer-to-peer) or submit additional information within 14 days of an AvMed UM denial. Part D denials require a member appeal. Delegated-entity denials follow the delegate's letter.
Mailing addressAvMed
Provider Claims Appeals
P. O. Box 569004
Miami, Florida 33256-9004
Non-par Medicare Advantage claim appeals.
Non-par providers appeal in writing within 60 days of the remittance advice with a signed Waiver of Liability; decision within 60 days. Provider Service Center 800-452-8633 for forms.
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Make the call count.
Find appeal teams, faxes and mailing addresses. Use the denial notice to confirm the appeal level, filing deadline and recipient.
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Denial notice, remittance and reason codes
Previous appeal confirmation and decision
Supporting evidence and any required authorization to represent the member
Questions to resolve
Is this a claim correction, provider dispute or member appeal?
What deadline and submission channel apply to this case?
How can the office confirm receipt and track the decision?
This is a general administrative checklist, not payer policy or advice about a particular patient. Confirm the current plan instructions.
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