tci Medicare Compliance & Reimbursement - 2006 Issue 9

APPEALS: Here's Who To Call To Get Appeals Settled Faster

Some carriers require redeterminations even for minor errors.The new and improved appeals process is causing headaches for some providers. As of Jan. 1, the first level of the appeals process became known as a "redetermination." For minor errors, carriers can "reopen" providers' claims instead of giving them a full "redetermination."But many of the details of the new process remain unclear, and the carriers haven't been too helpful. At least one carrier, National Health Insurance Corp., says it'll no longer process anything over the phone, even denials due to minor errors, according to Erica Schwalm, a biller...

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