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Essay / Research Paper Abstract
This 3 page paper looks at medical insurance, and outlined the concept of process of the general appeal process and then identifies three common potential sources of claim errors, discussing what they are they occur. The bibliography cites 3 sources.
Page Count:
3 pages (~225 words per page)
File: TS14_TEgenclaim.rtf
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Unformatted sample text from the term paper:
a claim may be appealed, if those receiving payment for benefiting from the payment, meaning the healthcare provider or the patient, do not agree with the decision.
The general appeal process starts when either the patient, or the service provider asks for the decision to be reviewed. The party that is asking
for the review is referred to as the appellant of the claimant. The general appeal process is the way in which an unfavorable decision may be questioned with the aim
of improving the decision, it may take place where claims been declined, or has only been partially excepted and full payment is not been made. Each payer will have a
set procedure for appeals, which may depend on the type of appeal being made. Prior to appeal the rules should be reviewed so that an appeal which is filed is
compliant, this will usually include filing the appeal with a set period of the claim being denied. In most cases there is an escalating structure that needs to be traversed
starting with a complaint, then moving to an appeal and then to a grievance. In soma cases there may need to be a minimum value hurdle met, so avoid wasting
time on small claims. In Medicare cases where there is a denial as a result of a minor error or omission there is not the need to make an
appeal, in these circumstances the provider can ask the payer to reopen the case, the error may then be rectified and the payment reassessed. Where a Medicare appeal is made
there is a 5 stage process. The first stage is re determination, where a Medicare employee who was not involved in the
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