module04_appealsprocess.docx - Appeals Process Assignment Answer Key <> For each reason indicate the appropriate action(Accept Resubmit or Appeal Then

module04_appealsprocess.docx - Appeals Process Assignment...

This preview shows page 1 - 2 out of 2 pages.

Appeals Process Assignment Answer Key < > For each reason, indicate the appropriate action (Accept, Resubmit, or Appeal). Then, provide the rationale for your decision using the rationale code in the Rationale Options section below the table (for example, D1). Reason for Denial, Rejection, or Partial Payment Indicate One of the Following Actions: Accept Resubmit Appeal Provide Rationale for Decision: The wrong diagnosis or procedure code was submitted. Resubmit D1 The service provided is only allowed once every 3 years. Accept A2 The payer determined the procedure to be experimental. Appeal B1 The services rendered do not meet Medical Necessity. Appeal E1 The diagnosis or procedure code(s) were missing. Resubmit C1 The procedure performed is not a covered benefit for the patient. Appeal A1 Information is missing or incomplete. No additional information is available. Accept B2 The service provided is paid at only 80% of charges.
Image of page 1
Image of page 2

You've reached the end of your free preview.

Want to read both pages?

  • Fall '18
  • Allie Kotzian
  • Law, Physician, 3 years, Char D2, London, Brighton and South Coast Railway locomotives

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture