Private-Payer-Advocacy-Templates-for-Appeal-Letters

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Private Payer Advocacy Templates for Appeal Letters

 
 
 
 

​​​Appeal letters are a collection of template letters that practices can utilize in appealing inappropriate carrier claims denials. It should be noted that even if claims are coded correctly, health plans may deny, reduce or recode claims and appealing such denials is the first step toward obtaining fair payment. Therefore, physician practices should appeal all inappropriately denied or amended claims.

General Appeals Information

  • National Correct Coding Initiative (NCCI) Edits: Description of NCCI Edits that identify pairs of services that normally should not be billed by the same physician for the same patient for the same date of service. Practices may use this narrative to explain the appropriateness of billing for certain pairs of services in certain circumstances
Appeal Letters for Office-based Labs

Utilize test methodologies that fit within the CLIA certification that your office laboratory holds and then select the appropriate CPT code based on the methodology performed. For a list of CLIA-waived tests, visit http://www.cms.gov/CLIA/.
 
Immunization
 
 
 
 
 
 
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National Correct Coding Initiative (NCCI) Edits: Description of NCCI Edits that identify pairs of services that normally should not be billed by the same physician for the same patient for the same date of service. Practices may use this narrative to explain the appropriateness of billing for certain pairs of services in certain circumstances.​
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