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MA
Appeals!
8
Type of plan that allows for pre-service appeals: Non-Grandfathered
Examiners don't have to prepare these two types of appeals: PPO disputes and Bloodhound denials
Who has formal appeal rights: Members, or providers who have been assigned appeal rights
Reprocess: If an examiner receives an appeal for a claim that was processed incorrectly, the examiner can simply ___________________ the claim.
Pre-Determination: If an appeal is pre-service, a copy of the _____________________must be included in the packet.
Chronolog note and Claim comment: It is important to note your actions taken regarding an appeal as both____________________.
EOB: Response to appeal when claim was processed incorrectly.
Red: Another term for a pre-service appeal.
Appeals!
1. | EOB | A. | PPO disputes and Bloodhound denials |
2. | Red | B. | Another term for a pre-service appeal. |
3. | Reprocess | C. | If an examiner receives an appeal for a claim that was processed incorrectly, the examiner can simply ___________________ the claim. |
4. | Pre-Determination | D. | Non-Grandfathered |
5. | Who has formal appeal rights | E. | Members, or providers who have been assigned appeal rights |
6. | Chronolog note and Claim comment | F. | Response to appeal when claim was processed incorrectly. |
7. | Type of plan that allows for pre-service appeals | G. | It is important to note your actions taken regarding an appeal as both____________________. |
8. | Examiners don't have to prepare these two types of appeals | H. | If an appeal is pre-service, a copy of the _____________________must be included in the packet. |
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Appeals!
1. | EOB → F |
2. | Red → B |
3. | Reprocess → C |
4. | Pre-Determination → H |
5. | Who has formal appeal rights → E |
6. | Chronolog note and Claim comment → G |
7. | Type of plan that allows for pre-service appeals → D |
8. | Examiners don't have to prepare these two types of appeals → A |
© 2013
PuzzleFast.com, Noncommercial Use Only