February 5, 2013

Greetings {ContactName|Appeal Letter Subscriber},

Appealing Lack of Timely Filing Denials

Are you just now learning about other primary coverage months after filing a claim with Medicare? CMS is undertaking a comprehensive effort to collect money owed to Medicare due to incorrect payments related to coordination of benefits and, as a result, providers may find themselves with timely filing denials from the primary insurer.  Read the article on Appealing Lack of Timely Filing After an MSP Denial and be sure to download the appeal letter which cites restrictions on the primary carrier's ability to assert the lack of timely filing defense. . . .

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AppealLettersOnline.com Featured Letters

Lack of Timely Filing Appeals
AppealLettersOnline.com has a letter for appealing lack of timely filing denials received from group health plans when an MSP claim was filed late due to failure to identify primary payer at the time of treatment. This letter cites Section 4632 of the Balanced Budget Act of 1997 which stipulates a three-year time frame for recoupment of incorrectly paid Medicare benefits and limits the applicability of the primary carrierís timely filing limitation to related refund demands. The letter is titled Request for Primary Payment Subsequent to MSP Refund and is available in the appeal repository under the Topic Timely Filing Limitation: Notification of Timely Filing.  If this appeal is not effective, you may want to discuss the group health planís denial with the Medicare MSP department for your region. 

The AppealLettersOnline.com Repository also has other state-specific letters to assist with Lack of Timely Filing denials.   These letters directly quote state requirements regarding timely filing if any exist.   There is also a letter which assists providers with submitted Proof of Timely Filing for the carrier's consideration in situations where the initial claim was timely filed but not received by the insurance carrier due to "address change, system failure or clerical error."

Letter to Assist With Payment Not In Compliance With Contractual Terms
The AppealLettersOnline.com Repository features a letter regarding failure to pay according to contractual terms.  The letter is located in the Topic Benefit Reductions: Miscellaneous under the letter title Payment Not In Compliance With Contract.  The letter assists providers with citing information directly from the contract and also asks the carrier to respond with detailed information regarding what portion of the contract was used to calculate the received payment.  The letter also states that since managed care contracts are contracts of adhesion, the organization responsible for drafting the contract wording can be responsible for unclear and ambiguous terms.

Letter To Assist With Silent PPO Appeals
We have a number of physician clients who report problems with incorrect payment which appear to be related to silent PPOs.  We have an appeal letter to assist medical practices with these appeals.  See the letter under the Topic Benefit Reductions: Miscellaneous, titled, Silent PPO.

Access these appeal letters at AppealLettersOnline.com

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