Claims Escalation
Claims Escalation Research & Resolution Process
Buckeye has excellent customer service through our Provider Services department who are dedicated to answering your questions and resolving issues. They are your first stop in a quest for information. See Provider Home page for phone #'s.
Medicaid & Behavioral Health Claims:
Effective February 01, 2023, when a Provider Service Representative is unable to answer or resolve your claims questions, they will generate a provider claim dispute and forward it on to the appropriate departments for review or reprocessing as needed. A case # will be generated and once submitted, the status and acknowledgement receipt of the dispute can be viewed in the Provider Web Portal.
Information on dispute tracking/status updates, access the Provider Home Page and login to our portal for additional details to access or request access to the Provider Web Portal.
NOTE: If the Provider Service Representative can answer your questions during the call, it is considered a first call resolution and the case will not be routed for additional review.
If you would like to submit a dispute instead with medical documentation attached, please refer to the Dispute-Appeals Process page.
Medicare & Ambetter Claims:
Buckeye has excellent customer service through our Provider Services department who are dedicated to answering your questions and resolving issues. They are your first stop in a quest for information. See Provider Home page for phone #'s.
Effective October 1, 2021, when a Provider Services representative is unable to answer or resolve your claims questions, they will provide you with a service reference number to place on our Claims Escalation Form. The form will connect you to an Internal Provider Relations Representative who will review your submission.
Submission process:
- Complete our Claims Escalation Form (attached below) and send it to Buckeye via email to:
Medical Claim issues medicalclaimsresearch@centene.com
Behavioral Health issues BHClaimsResearch@centene.com - Please submit one form for each claim/incident you want reviewed.
- Within 3-5 business days, you will receive notification we have received your submission.
Review Process:
- Please allow up to 30 days from the date of notification for your submission to be researched.
- Within 30 days, you will receive an email response from your Internal Provider Representative with one of the following:
a. Resolution to your submission and what to expect.
b. Notification that your submission is being reviewed by our internal operations team and the details
around the next steps being taken to resolve the issue. You will receive a reference number for this
portion of the review process. - In the event you don’t receive a response within the time provided in the notification, please reply to the notification email to follow up. Please be sure to include your reference number.
- Your Internal Provider Relations Representative will continue to communicate with you through this email address until the issue is resolved.