Can I request a pre‑service provider courtesy review?

Yes. The pre‑service review process hasn’t changed. If a pre‑service request is denied, you can contact American Imaging Management (AIM), Member Health Partnership Operations (MHPO), or ValueOptions to request a pre‑service Provider Courtesy Review (PCR).

If the PCR is denied, the member may request a Level I pre‑service appeal. If the service is performed and the claim is denied, both you and the member may request a post‑service Level I appeal, depending on the reason for the denial.

If the service is performed and denied as not medically necessary, both you and the member have appeal rights.

If the service is performed and denied due to no prior review, and the charges are determined to be provider liability, the denial is contractual and neither you nor the member may appeal.

Understanding the denial reason helps determine whether appeal rights apply and which options are available.