Appeal letter for when the service or CPT included in another service

Practice Address

22nd July 2010
                                   
Wellcare
Attn: Claims Dispute Resolution
PO BOX 31370
Tampa FL 33631-3370

Re: Appeal of Medical claim

Patient Name:
Health Insurer Identification Number:
Service Date: 06/27/2010
Claim Number:
Call Reference Number: 59046512


Dear Sir / Madam

We are appealing your decision and requesting reconsideration of attached claim that was denied for the procedure 99144 as “Payment included in allowance of other service/procedure.” On 07/12/2010

We feel this charge should be allowed for the following reason:

•    As per CMS Appendix G the procedure 99144 is not inclusive with any other procedure billed on this claim. Also I have attached the CMS Appendix G guidelines for the procedure 99144.

As per our discussion with customer service this claim paid under Medicare’s guidelines.

In this context, we request you to kindly have this claim reprocessed and reimburse Dr.  for the same.

Thank you for reviewing and reversing this claim denial. If you require any additional information, please contact me at 407-123 - 4567 between the hours of 8.00 a.m.-5.00 p.m.

Sincerely,


AR Specialist

(Account Receivable – Reimbursement Specialist)

Posted in: payment inclusive,sample appeal