Claim Review Request

Claim
Review Request

If you have a concern about how a claim processed, you can request a claim review, also called an allowable charge review. (Note: This process is separate from the  claims appeals process, which is only for charges denied as "not covered" or "not medically necessary.")

Common Reasons for a Claim Review

• Allowed amount disputes
• Charges denied as "Included in a paid service."
• Charges denied as "Requested information not received."
• Claim denied as "Provider not authorized."
• Claim Check denials
• Coding issues
• Cost-share and deductible issues
• Eligibility denials
• Other health insurance issues
• Penalties for no authorization
• Point of Service disputes (Exception: Point of Service for emergency services is appealable.)
• Third party liability issues
• Timely filing limit denials
• Wrong procedure code

How to Request a Review of Claim

Your request must be postmarked or received by Tribal Active Management Services Inc (TAMS) within 90 calendar days of the date on the beneficiary’s ONA Healthcare Explanation of Benefits.

Include the following:

• Letter with the reason for requesting the claim review
• Copy of the claim if available
• Copy of the explanation of benefits or provider remittance
• Supporting medical records
• Any new information that was not submitted with the original claim

 

Mail the request to:

ONA Healthcare – Claims Correspondence
897 Cayo Grande Ct

Thousand Oaks, CA 91320

24/7 Fax: 1-805-375-6090 or call us 1 888-511-0647 ext:108.

Pre-Authorization
Request pre-authorization request forms and send completed forms to our fax above or secure email to [email protected]

Claims
Request status and sent claim forms to our fax above or call us 1 888-511-0647 ext:108 [email protected]

Providers
Interested in becoming a in-network provider let’s have a conversation, call us 1 888-511-0647 ext:108, Email/Fax [email protected]