Payers
Every payer appeals differently. Here is what each one expects.
Same denial, same documentation — and a different deadline, a different route, and a different first step depending on who sent it. These guides cover the process each payer publishes, and the trap that costs practices the most on each one.
One rule holds everywhere: the deadline printed on your remittance advice or denial letter is the one that governs. Windows vary by contract, product line and state, and third-party sources routinely publish numbers that contradict the payers’ own material.
Commercial
Windows are set by your contract as much as by the payer, and the two large ones structure their steps differently.
- UnitedHealthcareUnitedHealthcare runs reconsideration first, then a formal appeal — and both steps share a single 12-month budget from the original denial.
- CignaCigna allows roughly 180 days to appeal — but the clock can run from the last payment adjustment rather than the original denial, which cuts both ways.
- AetnaAetna runs reconsideration and appeal as consecutive windows — 180 days for the first, then a fresh 60 days that only starts when the reconsideration decision lands.
Medicare Advantage
Appeals run through the plan first rather than through Medicare, and contracted and non-contracted providers follow different paths on the same plan.
Behavioral health carve-out
Behavioral health is frequently carved out to a separate administrator. Appeals sent to the health plan instead can sit unrouted until the window closes.
- Optum Behavioral HealthBehavioral health under a UnitedHealthcare plan is often administered by Optum — a separate operation with its own submission route, and sending the appeal to the wrong one wastes the window.
- Magellan HealthcareMagellan administers behavioral health under commercial, Medicaid, and federal contracts — and the deadline changes with the contract, not with the company.
- Carelon Behavioral HealthCarelon — formerly Beacon Health Options — administers behavioral health benefits for commercial plans, Medicaid agencies, and employers, each with its own appeal clock.
One process instead of seven
Upload the denial whoever sent it. Undeny reads the code, drafts the appeal letter, and tracks the deadline until the money comes back.