Appeals
If there are any discrepancies in the claims or if the insurance provider disagrees with the services and holds the reimbursements, you can then file an appeal. Medleeds helps you with filing the appeal, aiming at reimbursement. Here are a few common denial reasons that you may face.
When a claim can be appealed?
Well, we cannot appeal every rejected claim. There are specific reasons and eligibility to raise an appeal after the denial of the claim.
- Verify if the services are covered under the plan
- Verify if the benefits of the services are not exhausted
- Confirm the provider network with insurance.
- Check if we are within the time limit for submission
- Check if all the documents needed for appeal are necessary
Submissions:
Once you have the entire checklist ready for submission, the next step is to submit the appeal documents. You can get the mailing address, fax number, or email from the insurance company for sending in the documents for the appeal.
Checklist for filing flawless Appeal
Our professionals work on specific areas to form a pattern of regular follow-ups which would ease the process.
- Timely submissions:
Every insurance provider has their own time limit for submitting the appeals. The traditional time frame for submission is 120 days from the date of denial. However, the policies and timeframes differ with every state. Your appeal might be denied if you fail to submit the supporting documents within the appeal time limit.
- Add strong content and documents:
When submitting appeals, the most important thing is to add sufficient supporting documents. The cover letter is one such strong document that would help with explaining the reason for the appeal strong to the payer. When you pay proper attention to the cover letter, it gives a better chance for reimbursement.
Different Levels of Appeal
Generally, there are 5 levels of appeals upon which, the appeals would go only 2 levels from the billing support team.
- Level1: Redetermination
- Level2: Reconsideration
- Level3: Administrative Law Judge (ALJ)
- Level4: Departmental Appeals Board (DAB) Review
- Level5: Federal Court (Judicial) Review
How Medleeds help in the appeal process?
Since the above process is exhausting and time-consuming, Medleeds take initiative and helps you with appealing the claims
We collect the necessary information such as the contact address and channels of the insurance. Our team verifies the cover sheet that you prepare for the payer for easy reimbursement.
We prepare the cover sheet for your appeal with appropriate comments and attach the medical records accessed from PMS before sending it to the insurance.
Medleeds follow up with the insurance provider once the appeal is submitted. We also ensure that you receive the payment.
In case of further denial, we re-verify the documents and resubmit the same for further appeal.
