Claims Disputes

If a provider wishes to contest any claim payment, or reduction in reimbursement for specific procedures, the following actions must be taken within 60 days after receipt of the provider remittance or Explanation of Payment (EOP).

1. 1
   Complete the Claims Review/Dispute Form on the following page.
2. 2
   Attach all pertinent documentation.
3. 3
   Submit a copy of the original claim (marked “COPY”) and a copy of the EOP, which accompanied the original claim.
4. 4

   Mail all information to:

   Eye Management, Inc.
   P.O. Box 21730
   Attention: Claims Review
   Fort Lauderdale, FL 33335

   Do not call the office, fax information, or direct the information to any other department.

5. 5
   All attempts will be made to answer your response within thirty business days or sooner. However, at times, a claims dispute may be forwarded to the Peer Review Sub-Committee in which case you will be notified of this action, and the time expected before a response will be forthcoming.
6. 6
   Dispute must be submitted within 60 days of receipt of the EMI EOP. Receipt of dispute after 60 days will not be considered.