Sample appeal letter - Not covered when performed during the same session - denial

Practice Address

Phone# 407-123-4567

_______________________________________________________________________

05/07/2010  

Medicare
Attn: Appeals Department
PO BOX 2360
Jacksonville, FL, 32231

Re: Appeal of Medical Claim

Patient Name:
Health Insurer Identification Number: ID#
ICN: ICN#
Service Date: 04/10/2010

Dear Sir/Madam:

We are appealing your decision and requesting reconsideration of the attached claim that was denied on 04/29/2010 as “M80 - Not covered when performed during the same session/date as a previously processed service for the patient.”

We feel this charge should be allowed for the following reason(s):
 
•    The technical component of Baseline Polysomnogram and CPAP titration sleep study are performed on the dates 03/24/2010 and 03/28/2010 respectively. Both the procedures were interpreted by Dr. (Name) on 04/10/2010. Hence Dr. (Name) is due and eligible to get paid for the professional services that he had rendered.

Herewith I have attached the appeal pertaining for this claim with supporting Medical documents.

Now we are requesting you to reconsider our claim and reimburse Dr. (Name) 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,

specialist Name

(Account Receivable – Reimbursement Specialist)

Read more »

Insurance Appeal for medical necessity for additional service denial

Practice address

Phone# 789-123-4567

_______________________________________________________________________



05/07/2010



BCBS

Attn: Medical Review Department

PO BOX 1798

Jacksonville

FL  32231



Re: Appeal of Medical Claim



Patient Name:

Health Insurer Identification Number: XJBH3012008490

Claim Number: Q100000188728928

Call Reference Number: 1-17554020352

Service Date: 11/22/2009



Dear Sir/Madam:



We are appealing your decision and requesting reconsideration of the attached claim that was denied on 04/18/2010 as "MP907 – Documentation related to the date of service is needed from your physician to support medical necessity for the additional services.”



When we had a discussion with the BCBS customer service, the representative suggested us to file an appeal with the supporting Medical documents. Herewith I have attached the claim with supporting Medical documents.



Now we are requesting you to reconsider our claim and reimburse Dr. (Provider name) for the same.



Thank you for reviewing and reversing this claim denial. If you require any additional information, please contact me at 123-456-7890 between the hours of 8:00 a.m-5:00 p.m.



Sincerely,




Specialist Name

(Account Receivable – Reimbursement Specialist)

Read more »

Appeal letter - Global payment made to Facility - denial reason

Practice address

Phone# 407-123- 4567

_______________________________________________________________________
Date:

Careplus
Attn: Medical Records Department
4925, Independence Parkway Suite 300
Tampa, FL, 33634
Re: Appeal of Medical Claim

Patient Name:
Health Insurer Identification Number: 00101989701
Claim Number: 9111365798
Call Reference Number: 91111365797
Service Date: 09/18/2009


Dear Sir/Madam:

We are appealing your decision and requesting reconsideration of the attached claim that
was denied on 12/24/2009 as "Global payment made to Facility for this service. Seek
reimbursement for professional fees from facility appropriately."

We feel these charges should be allowed for the following reason(s):

• Dr. (provider name) is the only Physician who interpreted the service (Professional
component only) performed at  MRI Outpatient Hospital on
09/18/2009. Hence Dr. is due and eligible to get paid for the professional
services that he had rendered.

• St. MRI Hospital has billed Careplus for a global procedure in error.
This facility only performed the technical component.

Now we are requesting you to reconsider our claim, reverse the payment of professional
component from the other group and reimburse Dr. Mittal for the same.

When we had a discussion with the Careplus customer service, the representative
advised us to file an appeal with supporting medical documents. Herewith I have attached
the Claim form, Dr. Mittal's Intrepretation document and Careplus EOB.

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,
Henry Samuel
(Account Receivable – Reimbursement Specialist)

Read more »

Appeal to Humana - maximum allowable unit per day denial

Practice Address

Phone# 123-456-789

To
Humana
Attn: Appeals Department
PO BOX 14601
Lexington
KY – 40512

Dear Sir / Madam
Sub: Appeal of Medical claim
Attachments: Claim form, supporting Medical documents and denial EOB.
……………………
For patient Vonette Beckon (Service date: 02/20/2010) Humana denied this claim as
"Maximum allowable unit per day, since for the same service there is a claim from a
different doctor, that was paid,” claim# 388685142.

In this context we would like to inform you that the patient had developed left sided
chest pain two weeks prior to Hospital admission and was also treated in ER. The
cardiology group was called to consult the patient for chest pain and as a result of
which patient has been diagnosed with pulmonary embolism. Dr. Mittal did the
respiratory consult for pulmonary embolism.

Since both Dr. name and Cardiology claims contain pulmonary embolism as the
primary diagnosis Dr. name's claim has been denied as stated above. We have
herewith appealed the claim with Consultation documents and CTA records for your
reconsideration.

We request you to kindly have this claim re-processed and expedite reimbursement
on this claim.

If you have any clarifications on this, please feel free to call us at 123-456-789

Thanks and Regards
specialist Name
Accounts Receivable – Reimbursement Specialist

Read more »