Appeals

When your claims and services are denied payment it is important for providers to understand the reason for the denial and what they can do about it.

If your claim denial indicates that the carrier has determined that your services were not medically necessary, it is time to work with CB&C’s Appeal Team experts.

The Appeals Team at CB&C has extensive experience and a significant success rate when it comes to overturning medical necessity denials through the appeal process.

The keys to your success are in understanding:

  • The processes and time frames for addressing each denial.
  • How to  place the burden of proof for medical necessity upon the Plan Administrator.
  • The  requirements of documentation to support the clinical necessity of the care.

Put an end to lost revenue for medical necessity denials:

Does this process sound familiar? The provider sends a claim → The claim is pended for notes →  The provider sends the notes →  The carrier responds that the care has been deemed not medically necessary →  The provider then balance bills the patient → or even worse→ writes the balance off.

If you are not a CB&C Client, we can teach you –

  • How to be sure of your claims eligibility for a medical necessity appeal
  • You can turn the file over the CB&C Medical Necessity Appeals Team
  • Allow us to file the 1st level member appeal, the 2nd level member appeal, and all the way to APPROVAL
  • Appeal Management is an included benefit that CB&C Clients freely benefit from as part of their  full-service billing!

 

Filing medical necessity appeals is a process that has to become ‘routine’ in every office – STARTING NOW!

Call CB&C for information about this program

973-827-3544, ext. 320

 

How To Get Started

Order the Book and Do It Yourself!

The Medical Necessity Appeals Field Manual  

  • A  thorough and easy to use reference guide for understanding and  constructing your own successful medical necessity appeals.
  • Includes  sample forms and letters
  • Written  by Lynette Contreni-Bernier, founder and President of CB&C, Inc., an aggressive, service-driven company providing specialized billing for  specialized care. Through CB&C, Lynette has been supporting the  success of hundreds of Chiropractic Clients, Physical Therapy and Multi-Disciplinary Clinics as well as Pain Management Practices.  She is also an active Insurance Consultant for the Association of New Jersey Chiropractors.
  • Order  your copy today for $99.00!



 

Have it Done By The Experts!

  • Download  and Print the following forms: