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CHI St. Vincent/CommonSpirit Health opts out of Octave Blue Cross networks

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How to file an appeal

When Octave Blue Cross and Blue Shield denies a claim for benefits, the member receives an Explanation of Benefits (EOB) explaining the reason for the denial. The member has the right to file an appeal to request review of the denial of a claim in whole or in part. 

An appeal must be submitted in writing. The appeal should include member name, health plan ID number, a reference to the claim being appealed (such as a claim number), and date and provider of service. 

Appeal forms

Want to appeal a denied claim? Complete and submit this form with any additional information, and your request will be reviewed: 

  • Arkansas Blue Cross plans
  • Health Advantage plans
  • Octave Blue Cross plans
  • Blue Advantage plans
    • This form may only be used for the following groups: Arkansas Children’s, Inc., ARcare, Arkansas College of Health Education (ACHE), Bad Boy Mowers, LLC, Bryce Corporation, Central Arkansas Radiation Therapy Institute, Inc., City of Marion, CommonSpirit Health, E. Ritter Communications Holdings, LLC, Farmer's Bank and Trust, First Bank Corporation, FutureFuel, Jefferson Hospital Association, Inc., Klaasmeyer, Lexicon, Inc., LifePlus, Little John Transport, Nucor Corporation, Revolution Sustainable Solutions, LLC, Suzano Packaging, LLC, The Stephens Group, University of Central Arkansas, and Water Tech.
    • If your group is not on this list, contact your Human Resources office on instructions on how to file an appeal.

When to submit an appeal

Send your appeal within 180 days (about 6 months)* after the EOB is mailed to you or you access online. You can mail, fax or email** the signed written request to your health plan.

Where to submit an appeal

Send requests for review of a denial of benefits in writing to the address shown on the document. 

Write on the envelope: 
Internal Review Request 

When to expect a response

A review will be conducted of the claim for payment to ensure that there has not been an error in processing the claim. You will have a final decision mailed to you in writing within 60 days (about 2 months) after your request is received unless unusual circumstances require more review.

*Time frame and appeals process varies by plan. Please call the number on the back of your ID card to speak with a customer service representative to confirm your plan’s requirements.

** The mailing address, fax number and email address may vary by plan be sure to check your appeal form to ensure you have the correct information.