Appeals
The following will be effective on July 1, 2025 and apply only to pre-claim submissions.
Provider Appeals Procedure - Commercial
Provider Appeals Procedure - Medicare
Provider Appeals Procedure - Medicaid
Reconsiderations
Provider Claim Reconsideration Procedure
Provider Reconsideration Form
Download the form for requesting a claim review for members enrolled in Sentara Health Plans.
Behavioral Health Provider Reconsideration Form
Download the form for requesting a behavioral health claim review for members enrolled in Sentara Health Plans.
Medicare Waiver of Liability Statement
Non–contracted providers who have had a Medicare claim denied for payment and want to appeal, must submit a signed Waiver of Liability Form to us. By signing this form, you agree to not bill the member for the services that have been denied.
Program Integrity Audit Standards
Review the Sentara Health Plans Program Integrity Audit standards, including the process for reconsiderations and appeals of claims audit findings.