Find appeal teams, faxes and mailing addresses. Use the denial notice to confirm the appeal level, filing deadline and recipient.
fax appeals
VA unauthorized emergency care — Supplemental Claim
Official page read
Phone
No phone listed for this route
Fax
844-678-8979
Supplemental Claim requests concerning VA payment decisions for unauthorized emergency care.
Published hours
Not published in this record
Product, plan and location
va National contact — confirm product and location
Mailing addressClaims Intake Center, Attn: 104P Appeals, P.O. Box 4444, Janesville, WI 53547-4444
Supplemental Claim submission destination.
Use the current VA review instructions and applicable form. This is not an Optum/TriWest CCN dispute or a Veterans Care Agreement contract-dispute destination.
VA unauthorized emergency care — Higher-Level Review
Official page read
Phone
No phone listed for this route
Fax
844-678-8979
Higher-Level Review requests concerning VA payment decisions for unauthorized emergency care.
Published hours
Not published in this record
Product, plan and location
va National contact — confirm product and location
Mailing addressClaims Intake Center, Attn: 104P Appeals, P.O. Box 4444, Janesville, WI 53547-4444
Higher-Level Review submission destination.
Use the current VA review instructions and applicable form. This is not an Optum/TriWest CCN dispute or a Veterans Care Agreement contract-dispute destination.
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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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