Introduction
Yuzu administers many different benefit plans, with different claims and eligibility rules. We adjudicate appeals according to the Summary Plan Description (SPD) in the plan.
Common Reasons for Disputes / Appeals
Network Status. In most cases, Yuzu does not hold a direct contract with a provider. This means that if you are disputing your network status or discount, you will need to contact your representative at a particular network to confirm network status. If you have confirmed your network status, and believe there is still a mistake, reach out to us over email.
Missing Pre-Cert. If your claim was denied for a lack of pre-cert, you can retroactively get the pre-cert and attach it in your communication with Yuzu to expedite our processing of the claim. If you need information about how to get a pre-cert, please call our provider services line at 203-208-9898.
No Surprises Act (NSA) Disputes. If you are creating an NSA negotiation or submission, please notify disputes@yuzu.health. This email is only used for NSA disputes. This is the email that is listed on the EOP for eligible claims.
You may submit appeals to claims@yuzu.health.
Fax
You may submit appeals to Yuzu over fax. Please include all information about the claim you would like to appeal contact information on how you would like to be contacted in regards to your appeal. Our fax number is 347.774.9159.
❗❗❗ Note: You may NOT submit claims over Fax, they will not be considered. Please see Yuzu’s guide on how to submit claims here: https://yuzu.health/docs/guides/submitting-claims ❗❗❗