Coventry Reconsideration Form PDF Details

Coventry is a city that is located in the West Midlands of England. The city has a population of approximately 320,000 people, and it is considered to be the second largest city in the West Midlands. Recently, the Coventry City Council released a statement announcing their decision to reconsider their form submission process for redevelopment proposals. This announcement comes as great news to many businesses and developers who were hoping to submit proposals for the redevelopment of Coventry. As this process unfolds, we will keep you updated on any new developments. Thanks for reading!

Form NameCoventry Reconsideration Form
Form Length2 pages
Fillable fields0
Avg. time to fill out30 sec
Other nameskdcabellcvty, coventry reconsideration, Kentucky, coventry provider appeal form

Form Preview Example

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, 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

Melissa Powell

(270) 779-8943

Kristy Cabell

(502) 689-4894

Jon Gillispie

(502) 689-3748

Christy Vowels

(502) 794-0864

Donna Moor

(502) 689-3629

Krista Hubbard

(502) 689-4515

Barbara Jones

(502) 438-7963

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

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

Provider Relations Representative above.




CoventryCares of Kentucky


Attn: Kentucky Reconsideration Team


PO Box 781


London, Kentucky 40742




Corrected Claim

Proof of Timely


Request for





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


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