How to File a Successful Appeal

Filing a successful appeal

In a perfect world, all claims would be processed correctly the first time. In the world of medical billing, however, we know this is not always the case. Situations may arise where it becomes necessary to file an appeal. Knowing when and how can save time and frustration.

Here are a few key steps to make the process easier:

Ask the Right Questions

First, check with the payer to find out what is required for the appeal. Some important questions to ask the insurance company include:

  • Is there a time frame for filing an appeal following the denial of a claim? 
  • Does the appeal need to be filed in stages?
  • What forms are required and how do I obtain them? 
  • Is the patient’s permission required in order to file the appeal? If so, what forms does the patient need to fill out?
  • What is the specific mailing address, fax number or email address for appeal submission? 

Many insurances will not enter the appeal into their system for review if it is not sent to the correct department with all the necessary information and forms. Get ahead by asking the right questions.

Follow Up

Follow up for medical claims and appeals

Always keep a copy of the appeal on file for your reference. Appeal work does not end with a successful submission. Once you have allowed enough time for the documents to be received and reviewed, you will need to begin the follow-up process. 

A simple follow up phone call may prompt the insurance company to begin processing the appeal sooner. Most insurance companies should be able to provide you with a document number to verify that your appeal was received. Ask for an estimated time frame for finalizing the appeal. Most importantly, always make sure to obtain a reference number for the call. This will be essential for future follow-up conversations.

Keep Track of Time

On average, insurance companies allow 30-45 business days to finalize appeals. Formulating an informed strategy prior to submitting an appeal ensures a less stressful process with fewer follow-up calls. The sooner the process starts, the sooner it finishes – and the sooner you can be reimbursed!

For more on how AMPM works hard to get your claims paid, please see our benchmarks.

Disclaimer: The materials contained on this website are provided for informational purposes only and do not constitute legal or other professional advice on any subject matter. Advanced Medical Practice Management does not accept any responsibility for any loss which may arise from reliance on information contained on this site.