A Utilization
Management (UM) Appeal is defined as a written request from a provider to
review a claim that required an authorization or precertification affecting a claim’s payment.
This does not include provider appeals of pre-service determinations (unless required under ERISA),
claims status requests, telephone inquiries or post-service claims review regarding the application of
benefits or allowed amounts.
UM appeals must be filed pursuant to the timeliness requirements of the
applicable Agreement with BCBSF or within five years from payment date. BCBSF will not overturn
administrative claim denials based on the provider’s failure to comply with required procedures and time
frames. UM appeals should be sent to the address below with the following information:
• The completed Provider Appeal Form (available at www.bcbsfl.com).
• A copy of the remittance advice.
Send UM appeals to:
Blue Cross and Blue Shield of Florida
Provider Disputes Department
P.O. Box 43237
Jacksonville, FL 32203-3237
Note: For information on the appeal of pre-service and concurrent review
decisions refer to the Utilization Management Programs section.
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