Appeal Guidelines for Banner Health and Dental Plans
NEW FOR 2014:
If you have received a denial, please send in a written request stating what you are appealing. For your appeal to be processed, the following information must be included:
- Patient name
- Patient ID
- Mailing address
- Contact phone number
- Type of appeal: Benefit or Health Care (Medical, Pharmacy, Dental, Disability)
- Reason for appeal (Full details)
- Date of service and amount (if applicable)
- Claim or authorization reference number (if applicable)
- Be sure to include any other information to support your request for appeal
Mail your letter of appeal and supporting documentation to:
BANNER PLAN ADMINISTRATION
P.O. BOX 16423
ATTN: Benefit or Health Care APPEALS
MESA, AZ 85211‐6423
Or you may fax them to:
Benefit Appeals: (480) 684‐6966 Be sure to include “ATTENTION: BENEFIT APPEALS” on the cover sheet.
Health Care Appeals: (480) 684-5911. Be sure to include “ATTENTION: HEALTH CARE APPEALS” on the cover sheet.
If you are filing this appeal on behalf of someone else who is over the age of 18 years, please have them sign and date the authorized representative release form. Due to the HIPAA regulations, we cannot process an appeal without this signed release form.
If you need help with your appeal or have questions about the appeal process, please call the Service Center at (480) 684‐7070 in the Phoenix metropolitan area or (800) 827-2464 for all other areas.