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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