Reminder: Include the disputed code in your claim appeals

One small addition to your claim appeal submissions – the disputed code – can have a significant impact:

  • Reduced follow-up communications
  • Less administrative work for both your teams and ours
  • Quicker appeal resolution time

What’s an appeal?

When you make an appeal, you’re asking us to change either our reconsideration decision, utilization review decision or initial claim decision based on medical necessity or experimental / investigational coverage criteria.

We only offer one level of post-claim appeals.

What to include in your appeal

When submitting your appeal through prism, be sure to include the following:

  • Specifics on what was denied and cited reason for denial
  • Clinical documentation
  • Disputed code
  • Fee schedules
  • Plenty of detail
  • Any justification that supports your appeal

Complete and accurate information is key to a timely, fair appeal resolution.

Tips: What makes a good appeal

How to make an appeal