Non-Contract Provider Payment Reconsideration

A non-contract provider, on his or her own behalf, may request a reconsideration for a denied claim within 60 calendar days from the remittance notification date. The non-contract provider must complete and submit a Waiver of Liability (WOL) statement with the appeal, which provides that the non-contract provider will not bill the enrollee regardless of the outcome of the appeal.

• Non-contract providers who have executed a WOL are not required to complete the representative form because the provider is not representing the enrollee, and thus does not need a written representative form.
• Zing Health is not required to undertake a review of the appeal until or unless the WOL form is obtained.
• The adjudication timeframe begins when the WOL is received by Zing Health. If Zing Health does not receive the WOL by the end of the adjudication timeframe, we will issue a dismissal notice per the dismissal procedures set forth in this guidance.

The appeal should include supporting documentation, such as a copy of the original claim or remittance notification showing the denial and must include any clinical records and other documentation that supports the provider’s argument for reimbursement.

Payment Reconsideration Request should be mailed or fax to:

Attn: Provider Appeals

Zing Health

P.O. Box 1222

Chicago, IL. 60606

Fax: 1-844-917-4458

E-mail: [email protected]