![]() ![]() ![]() Availity Appeals tracker will update to Submitted status adding the case number for the dispute and the names of the documents included with the request. Will you send an acknowledgement that the dispute was received?įor disputes submitted online through our provider website on Availity, the user will receive an onscreen confirmation that includes a Case Number. For non-Medicare appeals, we’ll respond by mail.If no fax number is provided, we’ll respond by mail. For Medicare appeals, if a fax number is provided, we’ll respond by fax.Whether you send your appeal by mail, fax or online through our provider website on Availity, we will send you an appeal decision letter.Whether you send your non-Medicare reconsideration by phone call, mail, fax or online through our provider website on Availity, the reconsideration decision will be verbal, or an EOB.Whether you send your Medicare reconsideration by phone call, mail, fax or online through our provider website on Availity, the reconsideration decision will be verbal, an EOB or a decision letter by mail.When you submit a dispute online through our provider website on Availity, the process for determining whether it goes to a reconsideration or an appeal is determined by Aetna using the criteria above. The member appeal process applies to appeals related to pre-service or concurrent medical necessity decisions. ![]() For these types of issues, the practitioner and organizational provider appeal process applies only to appeals received subsequent to the services being rendered. ![]() Utilization review decisions are decisions made during the precertification, concurrent or retrospective review processes for services that require precertification.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |