File an Appeal (Level 2 Claim Appeals)

This is for providers and members to submit Level 2 Claim Appeals after a Level 1 Claim Appeal has been completed.


*Please note, there are required documents.

 
 

First and Last name

 

Located on your PEBP Insurance Card with the black and white PEBP logo in the upper-left hand corner. Any other number will result in additional delays.

 
 

If this claim is before 07/01/2022, it will start with "NEV"

 
 

You will be required to submit the following documents for consideration:


> Explanation of Benefits: From UMR

> Level 1 Claim Appeal: Your initial request for appeal sent to UMR.

> Level 1 Claim Appeal Determination: UMR response to your appeal.

> Level 2 Claim Appeal: A narrative for the appeal to PEBP.

> Any other documentation supporting the Level 2 Claim Appeal.


Failure to submit these documents may result in delayed processing or a rejected appeal.

Drop your files here
 

This is from UMR.

 

This is what was submitted to UMR.

 

This is from UMR.

 

Please provide your preferred contact e-mail address.

 
 
 

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