You bill the claim. No response. You rebill the claim. This time, you get a response – a duplicate claim denial. Yes, you are still in the dark regarding what action was taken on the initial claim. Even worse, you spend 45 minutes on the phone only to find out that customer service can only access the most recent submission.
AppealTraining.com has added an appeal letter to assist with appealing duplicate claim denials. The request outlines the providers’ right to full disclosure related to the original claim processing. The appeal letter, under the AppealTraining.com Topic “Stalled Claims,” includes the following language to demand review of the denial:
It is our understanding that the above referenced claim was fully or partially denied as a duplicate claim.
This appeal is to request an audit of benefits applied toward the dates of service in question in order to verify that the duplicate claim denial is correct. Further, we appreciate clarification regarding the date the original claim was paid, the amount of payment and to whom the benefits were released.
As you are likely aware, both state and federal disclosure laws as well as contract terms may be applicable and require the release of detailed information to substantiate an adverse benefit determination. If you believe this request does not fall under disclosure requirements, please provide a written explanation.
Thank you for your assistance in regards to this matter.
You can strengthen the appeal by attaching a copy of your assignment of benefits and demanding compliance with potential regulations regarding honoring the assignment. Including your assignment of benefits will also provide documentation regarding your rights to disclosure of the claim information.
Leave A Response