Overview
What is a Claim Appeal?
A claim appeal is a formal request to an insurance payer to reconsider a denied or underpaid claim. Appeals include documentation supporting why the claim should be paid or paid at a higher rate.Why are Claim Appeals important?
Appeals give you the opportunity to recover revenue from claims that were incorrectly denied or underpaid. Including supporting documentation and claim history increases the chances of a successful appeal.Workflow Instructions
Creating a Claim Appeal
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Navigate - To appeal claims, navigate to one of the following locations:
- The Superbill
- The Claims Manager (Billing → Claims Manager)
- The Patient’s Claims → Charges
- The Patient AR (Reports → AR - Patient)
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Start the Appeal - Click the Print button on the claim you would like to appeal. In the window that appears, click the Appeal button and confirm to start the appeal process. This will open a new window for you to complete the appeal.
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Generate Appeal - Fill out the required information and click the Generate Appeal button.
- To include the full clearinghouse history pulled directly from ClaimMD, select Include Claim History
- Additional supporting documents can be uploaded to the Appeal as well
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Submit the Appeal - Fill out all required fields on the Appeal, as well as any other fields you’d like to include. Once you generate the appeal, you can transmit it via the following methods:
- Electronic submission - Currently in Beta via ClaimMD, available for some payers
- Mailed by clearinghouse - Mailed on your behalf for an additional fee
- Faxed by clearinghouse - Faxed on your behalf for an additional fee
- Download and mail - Download the Appeal packet at no additional cost and mail it yourself
For information on additional fees, see Fees Associated with Elation Billing.