Coventry Reconsideration Form – Fill Out and Use This PDF

The Coventry Reconsideration Form serves as a critical tool for healthcare providers in the Kentucky Medicaid program, allowing them to request a reconsideration of a claim denial. By using this specific form, providers can submit standard claim corrections, provide evidence of timely filing, respond with requested additional information, or justify the absence of prior authorization for services denied. To ensure the timely and efficient processing of your submission, please click the button below to fill out and submit your Coventry Reconsideration Form.

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Coventry Reconsideration Form PDF Details

Streamlining the claims process for healthcare providers can often present challenges, especially when dealing with claim denials. For those navigating the CoventryCares of Kentucky Medicaid program, the Coventry Reconsideration Form exists as a vital tool aimed at simplifying the reconsideration requests for denied claims. This specialized form is designed not only for standard claim corrections but also provides a conduit for submitting proof of timely filing in cases of initial untimely filing denials, responding to requests for additional information such as emergency room notes or operative reports, and for instances where medical services were provided without prior authorization. It's a focused attempt to consolidate various post-claim considerations into a single, structured process. Filing this form requires sending it to a specific address, emphasizing the form's intended use exclusively for CoventryCares of Kentucky Medicaid claims. Detailed within the form are instructions on where to direct these submissions, alongside contact information for Provider Relations Representatives who are available to assist with any questions or concerns. By facilitating a better understanding of and access to this form, healthcare providers can more efficiently manage their Medicaid claim reconsiderations, potentially reducing the administrative burden and speeding up the resolution process.

Question	Answer
Form Name	Coventry Reconsideration Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	kdcabellcvty, coventry reconsideration, Kentucky, coventry provider appeal form

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Friday FAX

The week of ______________(date)

CoventryCares of Kentucky Medicaid Reconsideration Form

When filing reconsideration on a claim denial for your CoventryCares of Kentucky Medicaid claims, please use the attached form. For CoventryCares of Kentucky Medicaid, the address to submit to is different, so please use this form. For our Medicaid Plan, all correspondence must be sent to:

CoventryCares of Kentucky

Attn: Kentucky Reconsideration Team

P.O. Box 7812

London, Kentucky 40742

This form can be found on our website and directprovider.com, the addresses are listed below.

As always, do not hesitate to contact your Provider Relations Representative

with any questions or concerns:

Mark Leonard	(502) 794-1434	mxleonard1@cvty.com
Melissa Powell	(270) 779-8943	mnpowell@cvty.com
Kristy Cabell	(502) 689-4894	kdcabell@cvty.com
Jon Gillispie	(502) 689-3748	jdgillespie@cvty.com
Christy Vowels	(502) 794-0864	clvowels@cvty.com
Donna Moor	(502) 689-3629	dmmoor@cvty.com
Krista Hubbard	(502) 689-4515	kxhubbard@cvty.com
Barbara Jones	(502) 438-7963	bljones1@cvty.com

CoventryCares of Kentucky

Provider Relations Department

9900 Corporate Campus Dr, Ste1000.

Louisville, KY 40223

Provider Relations Fax: (855) 454-5584

Customer Service: (855) 300-5528

www.CoventryCaresKY.com www.directprovider.com

If you would like the weekly fax blast emailed to you rather then faxed, please notify your

Provider Relations Representative above.

CLAIM CORRECTION / RECONSIDERATION FORM

MAIL TO:	FROM:
CoventryCares of Kentucky
Attn: Kentucky Reconsideration Team	___________________________________
PO Box 781	___________________________________
London, Kentucky 40742	___________________________________
Telephone#	___________________________________

Corrected Claim	Proof of Timely	Requested	Request for
	Filing	Information	Reconsideration
Member Name:	________________________	Member ID Number:	_______________
Date(s) of Service:	________________________	Remittance Advice Date: _______________
Amount Billed:	________________________	Amount Paid:	_______________
Claim Number(s):	____________________________________________________________________

This form is to be used ONLY for:

∙Submission of a standard claim correction

∙Proof of timely filing for an initial untimely filing denial

∙Response to CoventryCares Kentucky regarding requests for additional information (i.e. ER notes, operative reports, primary carrier Explanation of Benefit/Remittance Advice, etc.)

∙Submission of medical records along with a summary of why authorization was not obtained for services denied for no authorization

Please use the space below to supply any other necessary information, along with your attachment(s), to enable thorough reconsideration:

________________________________________________________________________________

___________________________________	_____________________________________
Signature of Sender	Date

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Coventry Reconsideration Form – Fill Out and Use This PDF

Coventry Reconsideration Form PDF Details

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