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  • Writer's pictureMuhammad Sair Khan

Insurance Appeal Template for Medical Providers

Unfortunately, due to excessively denied medical claims, many providers have to write appeal letters to get paid for services that they've already provided. What's worse, is that many physicians don' t have the time it takes to write an effective appeal letter, or the proper staff and procedures in place that it takes to win an insurance or state appeal.

Follow the template below and check out our last blog post, "How Insurance Appeals Can Improve Your Revenue" to learn more about how to get denied claims paid.

Appeal template

In the top left corner of the letter, you will need to identify your practice or facility, the name of the patient, the policy ID number, patient’s date of birth, the dates of service in question and the claim number assigned by the insurance company.

Provider/facility name

Tax ID: 27-xxxxxxx

NPI: 123456789

Re: John Doe

ID# YMQxxxxxxx

Date of Birth: 06/08/1972

Dates of Service: 2/16 - 2/22/2017

Claim #: PWY0X9P2K00

DCN #: (If applicable)

Next, state the reason the claim was denied. Reference the denial reason code listed by the insurance company on the EOB. Provide a brief history of the patient's illness and why the service or treatment was medically necessary. Use evidence-based information to support your claim.

If there is an authorization number or record of a conversation between your office and the insurance company, include that and any relevant notes from the call that will help prove your case. You can also include clinical notes and any correspondence you received from the insurer regarding the claim.

Once you submit your appeal, you should follow-up with the insurance company to make sure it was received and is in process. Processing typically takes 90 days. Once the insurance company makes a decision, they will mail you a written notice that states the final determination and hopefully, a payment.

We are here to help

Consider the time it takes to research the denial reason, draft the letter, gather clinical notes and follow up to make sure the appeal is processing correctly. This is a job of its own - but an important one.

If claim denials and incorrect payments are reeking havoc on your accounts receivable, let us help. Schedule a consultation with our experienced billing team HERE.

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