How to Write a Medical Appeal Letter

Denied Claims in both Dental and Medical Claims has been sited at 62% of claims that are denied the first time can and should be covered. However, the untrained biller even who is a certified biller do not know the work arounds to be successful and not have to do it multiply time.

The most frustrating and common denial responses from carriers are the words “Denial upheld. No new information submitted.” A No-New-Info appeal response is a clear signal that your organization may be submitting form letter appeals without making claim-specific customizations to the appeal letter. Appeal form letters have become routine in the industry.

This course is a different approach to appeals, that can save you time, and keep patients from becoming upset.

What you will learn

• Learn how to use a template that you use to add the specific patient’s information, health and specific details with clarifications when appealing.
• Appeals are an opportunity to request disclosure from the payer regarding the specific policy of plan language used to make the decision.
• Always adding a disclosure request embedded within an appeal letter puts the payer at risk for non-compliance with certain disclosure laws regarding adverse benefit determinations. And adding a disclosure from the patient to appeal the claim.
• Learn– A lack of authorization appeal requires customization because there are several different scenarios which trigger the denial.

What you will be able to provide after this course:

Writing an appeal for any of the reasons that are put on the claim.

• Timely filing – Any timely filing appeal letter should be customized to cite the date of initial submission along with documentation of the original submission.
• Medical Necessity – Medical necessity appeals should be customized with extensive information from the patient medical record.
• Benefit Reduction/Down coding – Benefit reductions/discounting are often ambiguously applied to claims without sufficient explanation.
• It is good to start the letter by stating basic claim information and giving the denial reason. This paragraph should also indicate your desire to appeal the denial. Further, if you have obtained specific instructions in the denial letter, reference this information.

This course is FREE to members. Not a member yet? Click here to sign up