Provider Appeals

Submitting an Appeal

If you’d like to file an appeal request, please download and submit the appropriate appeal form below.

When filing an appeal, be sure to include all appropriate documentation to support the case for the appeal. Please submit one form per claim appealed, and adhere to the filing limit standards applicable to the prevailing network.

Incomplete appeal submissions will be returned unprocessed.

All appeal documentation should be mailed to:

Health Plans, Inc.
PO Box 5199
Westborough, MA 01581

PDF icon Health Plans General Provider Appeal Form

PDF icon Harvard Pilgrim Provider Appeal Form and Quick Reference Guide