Checkpoint: Purpose Of General Appeals Process

Purpose of General Appeals Process Checkpoint

The purpose of a General Appeals Process is used to challenge payer’s decision to reduce, deny or to downcode any claim. The provider however, can ask for a review of the payer’s decision. The patient also has a right to ask for a request of the appeal. The claimant or appellant is the one that is filing the appeal. That could be an individual who is the provider or the patient. The basic steps are simple of the appeal. This is where the payer has a consistent procedure to handle the appeal. This has to do with what kind of appeal it is. The practice staff does a review on the procedure before other actions are taken. The staff then takes the necessary steps to move