The Kalderos Customer Support team will review the information and documentation received via email. If an item is missing or incomplete, the Customer Support team will respond to the covered entity user via email and request the information needed to proceed. If the missing documentation or corrected information is not received within 60 days, the dispute will be considered closed.
If the dispute request is complete, the Customer Support team will respond to the covered entity indicating that the dispute information is ready to move to the next stage and provide an ETA for a dispute response.
The additional information provided by the covered entity will be provided to the drug manufacturer. If the manufacturer agrees that the additional information resolves the concern, the manufacturer must update the claim’s original payment decision from “fail” to “approve” or modify the “units approved” on a previously approved claim, which will cause the claim to be paid in the next scheduled rebate cycle.