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.