Author Topic: How to appeal for a claim  (Read 1830 times)

Philip

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How to appeal for a claim
« on: August 06, 2009, 10:02:42 PM »
we sent a claim to Insuarance company for homehealth . it is rejected. we sent a corrected claim. When I called 4-5 times, they said it is processing.Today I got a mail saying the claim is denied.Icalled and asked, they said there is no problem and they  will reprocess it.They said we will get the money within 15-60 days. Anybody please help? What should I do next? Do I have to appeal? How will I appeal ? What should I do next? Any body please advise;
Thanks
Suma

PMRNC

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Re: How to appeal for a claim
« Reply #1 on: August 06, 2009, 10:20:31 PM »
How can we or anyone help without knowing details? why was the claim denied?
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
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Pay_My_Claims

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Re: How to appeal for a claim
« Reply #2 on: August 07, 2009, 08:55:21 AM »
we sent a claim to Insuarance company for homehealth . it is rejected. we sent a corrected claim. When I called 4-5 times, they said it is processing.Today I got a mail saying the claim is denied.Icalled and asked, they said there is no problem and they  will reprocess it.They said we will get the money within 15-60 days. Anybody please help? What should I do next? Do I have to appeal? How will I appeal ? What should I do next? Any body please advise;
Thanks
Suma

You can't appeal something that hasn't been "denied" Your posts says it should pay within 15-60 days. Looks like you will be playing the waiting game. You can call after 15 days to check on the status.

Philip

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Re: How to appeal for a claim
« Reply #3 on: August 07, 2009, 06:24:37 PM »
 I got a mail saying the claim denied because the CBSA code is not correct..Then I called the Insurance company. They said everything is correct and they will reprocess it. ( They put me on hold and they said they are checking and forwarding the claim againto process)That's what happened.Then I asked how long it will take to proces. she said 15-60 days.They gave the reference number too.

PMRNC

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Re: How to appeal for a claim
« Reply #4 on: August 07, 2009, 07:37:07 PM »
Usually you don't get "a mail" that a claim was denied.. you get an EOB with the denial code listed. A CBSA error.. would cause the carrier to reject, so I suspect it was a matter of the claim rejecting in error NOT a denial, there is no denial for CBSA because that's on the carriers end.

You have two choices. Play the wait game and keep pestering them  or re-send it.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Philip

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Re: How to appeal for a claim
« Reply #5 on: August 09, 2009, 08:56:32 PM »
yes , it was an EOB. after I agot that,  I called and they said everything is correct. So as you said , I will wait few days and then resend it. Is that okay?