Resources to Decrease Denied Medical Claims.
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Home | Incorrect Payments & Reductions



Appeal Topics
Incorrect Payments & Reductions

Insurance carriers now exercise great control over both in- and out-of-network payment through implementing fee schedules, usual, customary, and reasonable (UCR) limitations, and, more insidiously, computerized payment methodologies for applying internal bundling, downcoding, and other price control features. Often, it is difficult to even determine how a medical claim was paid and whether these payment policies are applied consistently and fairly across all similar claims. Read more about how to appeal incorrect benefit calculations.


Topic Areas for Incorrect Payments & Reductions:

Incorrect Payment Appeals
When your organization appeals a incorrectly paid claim, is that appeal reviewed by man or machine? Unfortunately, most incorrect payment appeals are sent through the same electronic claim editing software which initially denied it. We have a number of tips for demanding a professional appeal review. . . .more >>

Demanding Disclosure of Fee Schedule and/or Benefit Calculation
Medical organizations have a right to know how benefits were calculated. Read our appeal hints to effectively demand disclosure of critical benefit calculation details. . . .more >>

Appealing Claims With Modifiers
Just when you thought modifiers usage was becoming understandable, the rules change. Modifiers allow for more precise coding. However, modifier use often triggers deeper discounts than anticipated. A well written appeal can assist you with explaining the specifics of the treatment and determining what coding criteria the payer is using when calculating modified codes. . . .more >>