Appeal letters are now easier to find and use.
Most appeal letters require a very customized appeal. That is why AppealTraining.com has more than 1600 letter options. However, frequent situations require medical billing professionals to appeal quickly with minimal denial detail.
AppealTraining.com introduces our Level I – Level II Basic Appeal Letters to address the practical challenges of day-to-day appeals. Basic appeal letters work well for situations where an appeal deadline is looming but the denial simply failed to provide sufficient information for a customized, time-consuming appeal.
The AppealTraining.com Level I Basic Appeals are a collection of basic demand letters focused on demanding disclosure of denial details. The focus of the Level I Basic Appeal Letter is to initiate the appeal and gain more detailed denial information if the denial is upheld. The AppealTraining.com Level II Basic Appeals are a collection of basic appeal letters requesting expert review of a denial so that you can be assured of a high quality review process for what may be your final appeal.
It works like this:
We have 12 basic denial types: Provider Type, Preexisting Condition, Claim Resubmission, Duplicate, Experimental/Investigational, Maximum Benefits, Incorrect Verification, Eligibility, Coding, Timely Filing, Refund/Recoupment and Other Exclusions/Limitations.
We have identified the type of information you would most likely need in order to fully understand the denial in each of those categories. For example, in an experimental/investigation appeal, you are likely to need the clinical criteria used in the decision-making and the name and credentials of the reviewer. In a coding scenario, you would likely need to know coding source used in making the decision and the name and credentials of the certified coder who reviewed the denial. Therefore each Level I appeal letter is a basic demand for denial details to support the denial. This information allows you to better assess the quality of the review and compliance with policy-specific criteria and definitions.
Level II appeals for each category are a demand for expert review. The Level II letters anticipate that one of the most common problems in appeal review is the failure of the reviewer to provide a highly-qualified reviewer. For example, in a experimental/investigation appeal, the Level II Basic Appeal Letter seeks a response from a peer reviewer in active practice with similar credentials as the treating provider. In a coding scenario, the Level II letters seeks a review from a certified coder with recent training in the specialty coding related to treatment. Therefore each Level II appeal letter is a basic demand for expert review of that type of denial.
When do you use the Basic Appeal Letters? Use the letters when the denial is just too ambiguous to develop a customized appeal or if the reviewer is clearly unqualified to assess the claim. Also, use the letters if you are approaching the appeal deadline and need to get an appeal out quickly. Most appeals are required to be filed within 180 days. Some deadlines are a little longer and some a little shorter. Either way, you must meet the deadline in order to gain access to the review process. Since your best shot at overturning the denial is high level reviews, such as external appeal review, it is important not to lose the opportunity to advance the appeal just because the initial appeal was not timely filed.
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