Provider courtesy review requests using the current Provider Review Form.
Published hours
Not published in this record
Product, plan and location
Confirm the exact product or service National contact — confirm product and location
Mailing addressDMBA, Attention: Courtesy Reviews, PO Box 45530, Salt Lake City, UT 84145
Provider courtesy-review requests.
A provider courtesy review is distinct from a plan participant’s benefit appeal. Source limits this process to specified post-adjudicated claim disputes and directs use of the current form.
Share a structured call experience or flag a contact correction. Submissions are reviewed before publication. Patient details, recordings and documents do not belong here.
Share a call experienceSuggest a contact correction
Call preparation · editorial guide
Make the call count.
Find appeal teams, faxes and mailing addresses. Use the denial notice to confirm the appeal level, filing deadline and recipient.
Have ready in your secure workspace
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.
For healthcare offices
Found the contact. Still need to make the call?
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For the people making the calls
Put payer follow-up on your office’s worklist.
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A request does not create an account or start a call. Use business contact information only. No patient information.
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