P.O. Box 487
Syosset, NY 11791
Phone: (800) 449-0738
Fax (800) 356-0488
Email: love_review@crosslandmed.com
 

Crossland Med has been selected as the Medical Necessity Dispute Resolution External Reviewer Organization as directed by the Love Settlement agreement.



Submit Medical Necessity External Review Requests:
Providers can submit Medical Necessity External Review requests by mail, fax or Online:

 

Downloadable Form: MNER Form


Mail:

Download the Medical Necessity External Review form. Print and mail the form to with the necessary supporting documentation, and filling fee to Crossland Med.  

           

            Crossland Med

            Attn: MNRO

            PO BOX 487.
           
Syosset, NY 11791

 

FAX:

Download the Medical Necessity External Review form. Print and fax the form and mail the necessary supporting documentation, and filling fee to Crossland:

 

 

            FAX: 1-800-356-0488

 

Online:

Providers can submit Medical Necessity External Review requests by completing the online form and electronically submitting to Crossland. (click on 'Next' at the bottom of the page to begin).


Fill out the web-site Online form and submit all information necessary to complete the Medical Necessity External Review referral and to pay the accompanying filing fee.

 

Required Information:
In order to complete a timely and comprehensive review, it is necessary to fill out the form in its entirety, with information for each member and each date of service in dispute:

Required Filing Fee:
The Love settlement requires Physicians and Physician Groups to submit a filing fee for each Medical Necessity External Review form submitted. Crossland will initiate the external review upon receipt of all information and filling fees. The fees are directed by the Love Settlement agreement:

  • $ 50 per appeal if the disputed amount is less then $1000
  • $ 250 per appeal if the disputed amount is more then $1000

 

 

  • Via check. Physicians or Physician Groups may remit the filing fee to:

Crossland Med
Attn: MNRO.
PO BOX 487
Syosset, NY 11791


Crossland will initiate the external review once the external review request form is received and filling fee funds are secure. If an appeal is overturned and in favor of the Physician or Physician Group Crossland will refund the filling fee. Click Next to continue. 


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