Are you using the Claim Research Request Form correctly?

Keep review of claim reconsideration requests timely and avoid unnecessary processing delays by knowing the appropriate use of the Claim Research Request Form (CRRF).

You’ll get the fastest response when you submit claim reconsideration requests through the Claims Appeals feature in Availity. If you can’t submit electronically, you may use the paper CRRF.

When should I submit a CRRF?

A CRRF is appropriate when requesting reconsideration of certain claim denials, including:

• Authorization denials related to failure to obtain required precertification, but only when there’s a compelling reason the services weren’t precertified and the request falls within timely filing guidelines
• Claim edit denials, when supporting documentation is available to support the reconsideration request
• Timely filing denials, when there’s a compelling reason why the claim could not be submitted within required filing limits
• Corrected claims submitted outside timely filing limits, which must must have a CRRF accompanying the request

All CRRF submissions must include any required supporting documentation and be submitted within 60 days of the Explanation of Payment (EOP) date. Requests submitted without required documentation or after the 60-day submission window will have the original denial upheld.

When is a CRRF not needed?

Submitting a CRRF when it isn't needed can slow resolution and create more administrative work.

Do not use a CRRF for:

• Replacement claims or voided claims
• Submit replacement claims as new claim transactions using the appropriate replacement claim process.
• Submit claim retractions electronically as a complete void/cancel claim using frequency code 8.
• Corrected claims that are still within timely filing guidelines
• Submit these electronically.
• Authorization denials when no compelling reason exists for the failure to precertify services
• Timely filing denials when no compelling reason exists for the late submission
• Questions about provider contracts or fee schedules
• Contact the provider engagement team at 800-876-5357.
• Tomorrow Health denials
• Contact Tomorrow Health directly for help.

Avoid processing delays with these CRRF tips

Following these best practices can expedite review and prevent unnecessary delays:

• Use the Claims Appeals function in Availity whenever possible for quicker processing.
• Submit only 1 claim per CRRF.
• Include the claim number and date of service on the form.
• Select the appropriate reconsideration reason and check the applicable box, such as Claim Edit or Coordination of Benefits (COB).
• Include all required supporting documentation with the initial submission.
• For timely filing reconsiderations, include proof of timely filing.
• Do not submit duplicate reconsideration requests.
• Remember that COB claims are not subject to timely filing requirements.
• Include the name and phone number of the person completing the form.

Processing time reminder

Upon receiving a complete CRRF, Geisinger Health Plan has up to 45 days to review and process the request. We’ll notify you of the determination through a new EOP and/or written correspondence.

By submitting complete and accurate CRRFs, including all required documentation, you’ll keep the request review process efficient.