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Unformatted text preview: Purpose of the General Appeals Process The general appeals method brings into action demanding the payer’s choice at what time a claim is refused, decreased, or down coded. Providers and patients do have the capability and right to ask for an appeal. Once the claim is denied or rejected, the appeals needs to be filed by a definite time (Valerius, Bayes, Newby & Seggern, 2008). If a claim is deniable on the grounds of possibly absent signatures, the claim form needs to be amended with the absent signatures and after that submitted again for the claim to be paid appropriately. The reason for claim reductions or denials can be billing errors. If a patient sees the doctor for a visit at the office and the insurance company obtains an invoice for the consult, the doctor would collect reimbursement on the consult and not collect anything on the visit. The claim might be refused, causing in the contributors necessity to petition the claim if a patient sees a spet although did not obtain...
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This note was uploaded on 09/24/2011 for the course HCR 230 0000000000 taught by Professor ????????????????? during the Summer '11 term at University of Phoenix.
- Summer '11