14
Aug
- Oliver Kyle
- Comments 0
Denial Appeal Tips for Denial Medical Claims
When you need a medical claim, you have a valid reason for it, mistakes can happen anywhere and anytime. There are many reasons why a medical claim can be denial. But there are also few steps you can take towards reversing the claim denial. If you follow these tips, you will have the chances of your denial appeal being a successful one.
Know Why the Claim was Denial
You should better know that what caused your medical claim, before you start your denial appeal. Your explanation of benefits (EOB) can provide you with an explanation by using codes. Most EOBs will even give you a key to these codes, so you can determine what they mean if you are unsure. You can contact the Payer that denial you and ask them yourself about the causes and errors, if you are still not sure. It is your right to have this information, so get whatever information you need to find out the source of the problem.
Eliminate Problems
Start eliminates your little problems and mistakes as sometimes, the problem can be resolved easily. It might be just a misspelled name or a data-entry error that can be fixed easily. You should check your documents first for errors. If you find any, get the insurance company to fix them before you move on. If the errors are made by medical provider, ask them to correct the issue and then resubmit the claim.
Gather Evidence
You should get all of the evidence you need to show that the services you’re asking to have covered are medically vital, before your denial appeal. Your denial appeal is more likely to be successful if you have evidence such as prescriptions from doctors or referrals, as well as all relevant medical history information. You must get the reference for your health plan’s medical guideline for whatever treatment you got. You can usually find these online using your health plan’s website.
Submit the Right Paperwork
A letter must be sent to insurance company to get a successful denial appeal. You should mention your claim number in your letter, as well as the number on your health insurance card. However, your claim could get processed more quickly if you use your insurance company’s standard appeals form. You should contact the insurance company directly to find out how you can appeal, and also you can figure out how to appeal the decision by reading the EOB you received.
Pay Attention to the Timeline
When you have called your insurance company for the first time, you have to follow up with them by the time as well. Put a system in place that will remind you to follow up with them. If a customer service agent informs you that they will resubmit your claim and that it could take a week to get processed, make a note to contact them after few days and see how everything is going with the claim. A denial appeal is more likely to be successful if you gently nudge the insurance company every now and then.