1. List four claim determinations that can be appealed? And what steps would you take and why?
2. Explain what an uncollectible account is.
3. Briefly explain procedures required for submission of an appeal.
An example of a claim determination that can be appealed is when the MA01 Group Reason Code is referenced to the claim. The MA01 is defined as: "If you do not agree with what we approved for these services, you may appeal our decision. [ To make sure that we are fair to you, we require another individual that did not process you initial claim to conduct the appeal. However, in order to be eligible for an appeal, you must write to us within 120 days of the date you received this notice, unless you have a good reason for being late." ***STEPS 1. Evaluate whether or not you should file a
claim: Did you know that just when you call your insurance company with a question about possibly filing a claim it is often recorded on your insurance record? It is important to keep your insurance record clean and one way is deciding whether or not you should file a claim. It doesn?t matter if the accident is your fault or not, you should ask yourself first if you can pay for the damage. Simply put, if you can pay for it yourself without financial hardship, don?t file the claim.
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jher000|Points 5976|
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Asked 10/23/2011 11:23:37 AM
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