Appealing Payment Decisions

• If you feel that a clean claim you submitted should have been paid differently, you have the right to dispute the payment from AveraAdvantage.
• The AveraAdvantage Provider Dispute Resolution process includes two (2) methods of appeal: (1) an initial verbal inquiry; and (2) a formal written provider dispute resolution request.
• To file a dispute, you may call Provider Relations at 1-866-414-0048 from 8 AM to 11 PM EST, 7 days a week.

Or send a written dispute resolution request to:

AveraAdvantage
9990 Richmond Avenue, Suite 300 North
Houston, Texas 77042
Attn: Provider Dispute Resolution

Fax: 713-978-6703

• Complete copy of our dispute resolution form.
• We will respond to all written disputes regarding claims within thirty (30) business days.
• All disputes regarding claims must be disputed within 365 days from the date we adjudicated or made an initial determination with respect to the particular claim that gave rise to the dispute.