The information and forms provided on this page are for Non- Contracted Providers ONLY. HPSJ contracted providers should sign into DRE for PDR information and submissions.
If you are trying to submit corrections on a claim, please follow the Corrected Claim submission guidelines.
If a claim was denied as a duplicate and you feel it denied in error, please make sure it was submitted with the appropriate documentation, modifiers or corrected claim submission indicator before you submit a dispute.
If a claim or claim line was denied for supporting documentation, please submit as Correspondence with the requested information.
Please select the form you would like to download from the following choices:
Appeal of Medical Necessity / Utilization Management Decision Original claim denied because of a denied authorization or partial authorization.