Insurance Denials and Appeals
Claims that have been rejected or denied are carefully reviewed and resolved as quickly as possible. We utilize a three level appeal approach and handle incorrect denials by calling the payers directly, appeal in writing with supporting documentation, and if necessary utilize the administrative appeals approach to submit higher level appeals.
1. In instances when a simple phone call can be made to the payer to discuss an improper denial, we call immediately. This is the fastest way to get a claim reprocessed or resolved. We also utilize the payer’s website to submit corrections for quicker response.
2. We will carefully review the denial and request supporting documentation from your office and submit a written appeal to the payer when claims have been denied incorrectly. Our appeals are then carefully tracked and escalated if necessary.
3. Claims that are still denied incorrectly after the appeal has submitted will either be handled directly with the local provider representative or we will escalate the appeal utilizing the payer’s administrative appeals process.
4. We will also verify that your reimbursements correspond to your negotiated fee schedules and appeal any underpayments as necessary.
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