Wednesday, September 15, 2010

Sample appeal letter - Not covered when performed during the same session - denial

Practice Address
Phone# 407-123-4567


Attn: Appeals Department
PO BOX 2360
Jacksonville, FL, 32231

Re: Appeal of Medical Claim

Patient Name:
Health Insurer Identification Number: 4732123456
ICN: 02101066656101234
Service Date: 04/10/2010

Dear Sir/Madam:

We are appealing your decision and requesting reconsideration of the attached claim that was denied on 04/29/2010 as “M80 - Not covered when performed during the same session/date as a previously processed service for the patient.”

We feel this charge should be allowed for the following reason(s):
•    The technical component of Baseline Polysomnogram and CPAP titration sleep study are performed on the dates 03/24/2010 and 03/28/2010 respectively. Both the procedures were interpreted by Dr. (Name) on 04/10/2010. Hence Dr. (Name) is due and eligible to get paid for the professional services that he had rendered.

Herewith I have attached the appeal pertaining for this claim with supporting Medical documents.

Now we are requesting you to reconsider our claim and reimburse Dr. (Name) for the same.

Thank you for reviewing and reversing this claim denial. If you require any additional information, please contact me at 407-123-4567 between the hours of 8:00 a.m-5:00 p.m.


(Account Receivable – Reimbursement Specialist)

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