Provider Claim Escalation

We are proud to provide excellent customer service through our Provider Services department who are dedicated to answering your questions and resolving issues. They are your first stop in a quest for information:

PA Health and Wellness Community HealthChoices (Medical Assistance): 844-626-6813
Wellcare by Allwell (Medicare – HMO): 855-766-1456
Wellcare by Allwell (Medicare – DSNP): 866-330-9368
Ambetter from PA Health & Wellness (Commercial): 833-510-4727

Self-service tools are also available online 24/7 by visiting our secure Provider Portal options at www.Availity.com or provider.pahealthwellness.com.

Already called Provider Services? Get your Call Reference Number ready & continue on below!

What to Expect

Within 3-5 business days, you will receive confirmation at the email address provided that we have received your submission.
In 30 days or more you will receive an email response from your Internal Provider Relations Team with resolution to your submission and what to expect.
Your Provider Relations team will continue to communicate with you through this email address until the issue is resolved.
In the event you don't receive a response within the time provided in the notification, please reply to the notification email to follow-up or email phwproviderrelations@pahealthwellness.com.

Provider Claim Escalation Request (Form)

Fields marked with an asterisk (*) are required.

Call Interaction ID# from Provider Services (Must include Ticket # to be reviewed): *

If you haven’t called Provider Services yet, please reach out at:

PA Health & Wellness (Community HealthChoices): 844-626-6813
Wellcare by Allwell (Medicare – HMO): 855-766-1456
Wellcare by Allwell (Medicare – DSNP): 866-330-9368
Ambetter from PA Health & Wellness (Commercial): 833-510-4727

Billing Provider Name: *

Point of Contact for follow-up (First & Last Name): *

Preferred Phone: *

Preferred Email: *

Billing Tax ID Number: *

Provider NPI (if applicable):

Claim Issue Type (select all that apply): * Underpayment/Denial Overpayment/Refund Rejected Claim(s) Missing Payment Timely Filing Eligibility Claim Reconsideration Other – See Description of Issue

Description of Issue: *

Explain desired outcome:

Total # of Claims Impacted:

List Claim Number(s) if less than 5 – If total # of claims is greater than 5, we will reach out to provide you a copy of our claims template to complete. *

Dates of Service (MM/DD/YYYY-MM/DD/YYYY):

Missing Payment/Check Number(s) (Attach correct remit address & W9):

Related Authorization Number(s):