Payer guide · Optum
Optum Behavioral Health
UnitedHealthcare's behavioral health manager: the two-step claim dispute, 180-day clinical appeals, peer review and LOCUS/ASAM criteria.
Payer guides
Behavioral-health appeal rules by payer.
Who manages behavioral health for each payer, the appeal routes and windows in its own manual, how to reach a peer reviewer, which criteria it names and where to submit. Each guide links the payer's official pages and the date we checked them.
8 guides · verified October 14, 2026 · free, no account
Payer guide · Aetna
Aetna Behavioral Health
Reconsideration for coding and payment, straight-to-appeal for medical necessity, peer review before appeal, LOCUS and ASAM criteria.
Payer guide · Cigna / Evernorth
Cigna / Evernorth Behavioral Health
Who can appeal which Cigna denial, the 180-day window, peer review before appeal, MCG and ASAM criteria, and the person-only submission rule.
Payer guide · Carelon
Carelon Behavioral Health
Formerly Beacon: clinical and administrative appeals, 180-day Level I window, 72-hour expedited decisions and the criteria order Carelon applies.
Payer guide · Anthem / BCBS
Anthem Blue Cross and Blue Shield
Carelon decides, Anthem pays: clinical appeals, state-by-state payment dispute windows, Availity peer-to-peer and BlueCard routing.
Payer guide · Magellan
Magellan Healthcare
A Centene company: dispute or member appeal, the 90-day claims appeal, peer review and Magellan Care Guidelines with ASAM.
Payer guide · Medicaid
Medicaid managed care appeals
42 CFR 438 Subpart F: 60 days to appeal, 30-day and 72-hour decisions, continued benefits, case file rights and the state fair hearing.
Payer guide · Medicare Advantage
Medicare Advantage appeals
Organization determination, 65-day reconsideration, automatic IRE review, ALJ and beyond, plus provider and discharge rules.
ClaimParrot is not affiliated with any payer listed here; names are trademarks of their owners. Guides are general information, not legal advice. The denial notice, the member's plan documents and your provider agreement control when they differ from a guide.
Count your deadline with the appeal deadline calculator, request the criteria with the criteria request letter, and start the letter from the template library.
The notice controls.We show you where to look.