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Buckeye provider adjustment request form

Buckeye provider adjustment request form 2025

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The Provider Adjustment Request Form is designed for healthcare providers to request a review of claim payments that do not match expected amounts. Requests must be submitted within 180 days of the original claim disposition and require specific information including provider details, member information, and reasons for adjustment. The form also outlines submission instructions for Medicaid and Medicare claims.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (140 Votes)
2011	4.4 Satisfied (68 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What kind of insurance is Buckeye Community health Plan?

Buckeye Health Plan is contracted with the Ohio Department of Medicaid as a care coordination plan, and has been providing Medicaid and other government health services since 2004. Buckeye has earned the Commendable Health Plan Accreditation status from the National Committee for Quality Assurance.

How do I appeal my Buckeye health plan provider?

Your provider can contact us at 1-866-296-8731 for questions related to grievances and appeals. For help with complaints, grievances, and information requests, you can also contact CMS by calling 1-800-MEDICARE (1-800-633-4227) or TTY 1-877-486-2048.

Is Buckeye considered Medicaid?

Buckeye Health is a Medicaid plan for adults and children in Ohio. Eligibility is determined by family size and income.

What comes under Medicaid?

Mandatory benefits include services including inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services, among others. Optional benefits include services including prescription drugs, case management, physical therapy, and occupational therapy.

Where do I mail my Buckeye Health Plan refund?

For claim reimbursement, complete and mail this form to Pharmacy Services, 5 River Park Place East, Suite 210, Fresno, CA 93720.

What is the timely filing limit for Buckeye Medicaid corrected claims?

Submit the Adjustment within 180 days from the date of the EOP.

Is community health group Medicare or Medicaid?

CommuniCare Advantage (HMOD-SNP) is an HMO D-SNP health plan with a Medicare contract and a contract with the Medi-Cal program.

How do I apply for Medicaid in Buckeye Ohio?

Enrollment is done through the Department of Medicaid, located on the web at .medicaid.ohio.gov or by calling the Medicaid hotline at 1-800-324-8680.

Buckeye provider adjustment request form 2025

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