Transcription of Appeal Form - CareCentrix
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Appeal Form - CareCentrix
Appeal form Instructions: This form is to be completed by providers to request a claim Appeal for members enrolled in a plan managed by CareCentrix . This form should only be used for claim Appeals; corrected claims & claim reconsiderations should not use this form . Mail address: Send all Appeal requests to: CareCentrix Appeals PO BOX 30721-3721 Tampa, FL 33630 *Please be advised, Federal Express, UPS and Certified Mail cannot be delivered to a Post Office Box, therefore, providers should send those claims to: CareCentrix Appeals 10004 N. Dale Mabry Hwy. Suite 106 Tampa, FL 33618 Do NOT use this form if changes have been made to this claim.
Appeal Form Instructions: This form is to be completed by providers to request a claim Appeal for members enrolled in a plan managed by CareCentrix. This form should only be used for claim Appeals; corrected claims & claim reconsiderations should not use this form.
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