Display Appeal Letters

The Appeal Letters option allows the user to select and mail an appeal letter with the denial.  The user may choose from a set list of appeal letters.  The denial information is automatically populated into the letter, but the user may make changes to the body of the letter.  The letter can be printed and/or saved.  

 

The available appeal letters include:

• Addiction Predestination InVitro
• Aetna Provider Complaint and Appeal Request
• Cigna HealthSpring Request for Appeal or Reconsideration
• Denials Underpayment Letter
• Documentation for Remark Code
• Experimental Rebuttal Letter
• Generic Appeal Letter
• Generic Appeal Letter 2
• Inadvertent Coding Error Letter
• Lack of Authorization Emergency Room Letter
• Lack of Authorization Illness Injury Letter
• Lack of Authorization In Network Facility Letter
• Lack of Recognition of CPT Modifier 25 Letter
• Lack of Recognition of CPT Modifier 59 Letter
• Medical Necessity Denial Letter
• Timely Filing Letter

 

Note: The Signature Setup feature is unavailable for the three (3) Lack of Authorization letters.

 

To generate an appeal letter:

1. Click Display Appeal Letters from the Account Details screen.  The Appeal Letter window displays.

2. Choose a template from the drop-down menu.  The body of the letter populates in the window.

3. Select a signature from the drop-down menu.  Signatures are created in the Signature Setup tab.  Once selected, the signature displays in the generated appeal letter.

4. Users may edit the insurance information, if necessary.  This is useful when an appeal letter needs to be sent to multiple locations.  Place cursor in the address field and edit as needed.  The new insurance address will populate in the appeal letter when generated.

5. Make any necessary changes to the body of the letter and click Generate Appeal to create the letter.  The letter displays in a new browser window.  Click Print to print the letter.

6. When a user clicks Generate Appeal, the appeal letter is automatically saved in the Documents tab in the Workspace.  Click the File Name to view the letter.

7. When completed, click Save to save the letter, if desired. The letter is automatically saved to the Documents tab in addition to the desktop.

 

If the user selects the Aetna Provider Complaint and Appeal Request, editable fields display on the screen.  These fields coincide with the fields used on the Aetna Practitioner and Provider Complaint and Appeal Request form.  Users are able to enter data in the available fields, which populates into the Aetna appeal form, and then save the form as a .pdf.

 

The Appeal Letters feature also includes an option to populate remittance information directly into specific fields in the letter.  This process makes the Appeal Letters function easier to use since less data is required to be entered by the user.  Fields which require user input are easily viewable.  If the data is not present in the denial, the user is able to key it in manually.  

 

Standardized data from the remit to be automatically populated into the appeal letter where it matches the field includes:

Remit Field	Appeal Letter Key
Payer Name	Health Plan
Patient Name	Patient Name
Insured/Subscriber Name	Insured Name
Rendering Provider	Physician Name
Total Claim Charge Amount	Claim Dollar Total
Date/Time Qualifier	Date of Service
Claim Received Date	Received Date
Payer Claim Control Number	DCN
Subscriber Identifier	Member ID

 

 

 

 

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