Purpose of General Appeals Process Essay

The purpose of a everyday Appeals Process is used to ch completelyenge payers decision to reduce, deny or to downcode any use up. The provider however, can ask for a review of the payers decision. The patient also has a right-hand(a) to ask for a request of the appeal. The claimant or plaintiff in error is the one that is filing the appeal. That could be an individual who is the provider or the patient. The basic steps argon artless of the appeal. This is where the payer has a consistent procedure to deal out the appeal. This has to do with what kind of appeal it is. The practice lag does a review on the procedure forward other actions ar channelisen. The staff then takes the obligatory steps to move forward. The appeals must(prenominal) be filed by a certain time after the determination. The payers must go through three steps. These steps are a complaint, an appeal and the grievance.There is not a bunch of time to spend on this procedure. after this is done and the paye r is still denying the claim, the claimant can take another step. This can be reviewed through the tell insurance commissions since most payers are licensed through them. The state insurance commissions must have all copies of the file and to see why the claim was denied. The argue that the claim was denied to could be simple reasons. The reasons are loosely human error. The most common claim denials are due to not using the patients health care identification number and the classify name on the card. The other reasoning could be not putting down where the services were done. The cultivation but not least could be handicap diagnosis codes. This could all be why the claim is denied.ReferencesNyman, Ronald E., ESQ, (June 2007), MediStar Meducation , Volume 1, Number 4, www.credentialsxpress.com/newsletters/newsletter1-4 full.htm, Retrieved September 10,2010, Google.