Week 6 CheckPoint Purpose of the General Appeals

Week 6 CheckPoint Purpose of the General Appeals - The...

Info iconThis preview shows pages 1–2. Sign up to view the full content.

View Full Document Right Arrow Icon
The General Appeal Process The General Appeal Process was designed to allow one to appeal decisions concerning medical claims that one does not agree with. The General appeals process can be used to challenge the payer’s decision regarding the insurance claim. The medical provider cans begin the appeal process by first asking that the decision of the payer be reviewed. A patient also has the right to request an appeal concerning a claim decision in which they are not in agreement with. If a claim is denied for payment it could be the result of a variety of simple overlooked mistakes (Valerius et al., 2008). The following are some of the most common billing errors that could cause general appeal; Coding errors (incorrect unbundling, procedure codes not payable by plan with the reported diagnosis codes) Doctors do make mistakes. Doctors often write in the wrong insurance code (Vogin, 1996-2010). Billing errors, such as failure to get required pre-authorizations or referral numbers
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Image of page 2
This is the end of the preview. Sign up to access the rest of the document.

Page1 / 2

Week 6 CheckPoint Purpose of the General Appeals - The...

This preview shows document pages 1 - 2. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online