jasmina's FotoPage

By: jasmina helen

[Recommend this Fotopage] | [Share this Fotopage]
Saturday, 1-Jan-2011 07:18 Email | Share | | Bookmark
Step by Step Tips to Appeal Denied Medical Claims Successfully

Appealing denied claims used to be a simple process. A biller working with a physician’s office would stamp “APPEAL” in big red letters on a photocopy of the claim, and mail it back to the insurance company. These days, you’d be wise to put the cost of that postage in the bank, and throw away both the APPEAL stamp and its red ink stamp pad. This sort of knee-jerk response won’t even make it past the insurance company’s initial computer screening; they’ll likely toss such “appeals” into the trash and you’ll never hear anything back from them.

To successfully appeal denied claims, you need to get your “A-game” on; otherwise, you won’t see a penny for your efforts.

Follow these steps to effectively appeal denied claims.

1. Recognize denials. Insurance companies don’t print the word “denied” in big letters across the top of the claim form. In fact, the word “denied” may never appear at all. The insurance company simply declares the reimbursement amount to be “$0″ and enters an adjustment reason code next to the amount paid. The key is to identify it as separate and distinct from a contractual adjustment, which is – and should be – a write off.

2. Understand why the claim was denied. Before you pick up the phone and demand to speak to the claims representative, determine the root cause of the denial. You can’t effectively appeal until you know why payment for the service was denied. In addition to the reason code, there is a remark code. Look up the insurance company’s definition of that code to get details about the reason for the denial. WPC maintains a complete listing of standard reason and remark codes, available on their website.

3. Don’t procrastinate. There is often a timeframe in which you can resubmit a claim after it’s been denied. Pull the record, research the code, call the patient, etc., but don’t delay: most insurers only allow a few months to resubmit a claim for reconsideration.

4. Follow the insurance company’s rules. Each insurer has an appeal process. The Centers for Medicare and Medicaid Services (CMS), for example, has a form to complete when appealing the denial of a Medicare claim called the “Medicare Redetermination Request Form”. Get familiar with the insurer’s protocols to understand your options if your first appeal is turned down. Don’t give up; most insurers have multiple levels of appeals and even a grievance process if you disagree with the outcome after you’ve exhausted the appeals process.

Health insurance for students

Health insurance for unemployed

Saturday, 7-Aug-2010 11:59 Email | Share | | Bookmark
What are the types of Term Life Insurance Policies?

A Policy holder that died after the policy term has passed will not be eligible for the compensation. There are many types of term life insurance policies including annually renewable, guaranteed level, return of premium term life insurance policies.

Annually renewable insurance will automatically renew every year as long as you pay the premium. The policy period ranges from 1 – 30 years. It is less expensive that the permanent insurance so it is suitable for people that have a tight budget. Unlike permanent policies, it does not offer cash value and build up equity. Depending on the company, your premium rate may be fixed or adjusted periodically. Some insurance company allows you to convert the annually renewable life insurance to a permanent insurance without undergoing a medical exam. However, you will be charged with a higher premium rate after you converted it to permanent insurance.

Guaranteed level term insurance offers level premiums for a designated period. The period can last from five to thirty years. It is one of the most preferred policies among consumers because of its cheap price. Most companies will offer a guaranteed level premium. Fraud companies will not offer such guarantees so you should be avoid them. If the company does not offer a guarantee level premium, it may increase your rate. At the end of the policy term, you can choose to renew the policy but you will be charged with annual premium rate that will increase yearly.

Health insurance for students

Health insurance for unemployed


© Pidgin Technologies Ltd. 2016