Friday, July 8, 2016

Appeal letter to process the out of network claim when treated on emergency

Practice address
Po box 1234
Kenneth City FL-123456

Georgia Medicaid
Attn: Claims Department
PO Box: 7000
McRae, GA- 31055

Re: Out of state Medical Claim
Patient Name:
Insured’s Identification Number: 11107639099123
Service Date: 06/26/2010 to 07/02/2010
Call Reference#: 972217511

Dear Sir/Madam,

This is to report a claim for a service rendered in out of network state Florida. Patient was admitted in  Hospital on 06/25/2010 with acute respiratory failure which required urgent care and was referred to Dr  for an intensive consultation on 06/26/2010 and for further review till 07/02/2010. Hence we would like to request you to take the above situation into consideration and have the claims reimbursed at the earliest possible.

Herewith all supporting Medical documents are attached.

Incase of any queries or clarifications please call (407)123-4569 between 8.00 AM and 5.00 PM Monday through Friday Eastern Time.


(Account Receivable- Reimbursement Specialist)

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