ASi NEEDS ONLY THE FOLLOWING DOCUMENTS IN
ORDER TO APPEAL A DENIED INSURANCE CLAIM.
ORDER TO APPEAL A DENIED INSURANCE CLAIM.
- Copies of the UB-04, HCFA 1500, or other billing.
- Copies of the explanations of benefits (EOB) from the insurance carrier.
- Copies of correspondence from the insurance carrier.
- Copies of notes related to the patient’s account history.
- Copies of medical records (including notes from physicians).
- A copy of the contract with the insurance carrier.
BELOW ARE OPTIONS FOR
ACQUIRING DOCUMENTATION.
ACQUIRING DOCUMENTATION.
If you are a facility or a group, there are three options:
- Your staff may gather the documents for us.
- Our staff will pull and copy the documents on site.
- We can retrieve the information electronically through a VPN connection to your software system.
If you are an individual, we will provide a list of the documents we need, and you may send them to us.
For your convenience, an appointment of representative form (CMS Form 1696) is available in both English and Spanish at www.medicare.gov/basics/forms/default.asp.