Sunday, May 30, 2010

Appeal instruction from - TechHealth insurance

Appeal instructions:

An appeal is necessary when a payment on any one date of service/and or CPT code has been short paid, or denied, either formally or on the explanation of payment.

If you are billing more than one date of service on any single claim and you have not received a denial and one or more of the dates of service on the claim have been paid please fax your claim with a cover sheet in which states Partial Payment Appeal and fax it to the attention of the Quality Department.
Appeals must include the dates of service and CPT codes that have been under paid.  *A/R statements showing charges and invoices, or itemized claims will be not accepted and a formal denial of payment will be sent in return.
All documentation listed below will be required with appeal submission, if any piece of necessary information is missing, a formal denial of the appeal will be sent back to you.
Please fax all Appeals to 813-490-1915 Attention : Quality Department

- Copy of original claim.

- Letter detailing the appeal.

- Copy of TechHealth’s authorization, all other payers authorizations or the
letter of medical necessity will not be accepted as authorization. As it clearly
states in our contracts that TechHealth will provide separate authorization
confirmations to our providers, for items or services in which are payable
through TechHealth. A letter of Agreement is not authorization but a letter
defining the relationship between TechHealth and the provider.

- The Letter of Agreement or a copy of your reimbursement schedule
supporting your appeal.

- Proof of timely filing. ( This only applies to payments denied for timely filing)

o A certified mail receipt or Fed Ex,UPS tracking receipts. All others will be considered with significant proof. TechHealth can not be held liable for the USPS or fax machine inaccuracies or malfunctions.

Timely filing is based on receipt of your claim. Only legal proof of timely filing will guarantee an over ride of the original denial.

Note: Please review the timely filing of your appeals per your contract prior to submitting the appeal, as this can also result in denial.

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