Appeals information

Appealing?

What do you need to do?

Submit (i) a copy of the Revised Explanation of Benefits you received from ClaimReturn, (ii) the explanation of your dispute detailing why you feel the claim was billed properly
initially, and (iii) all relevant documentation to support your dispute.

If procedure codes are cited in the Appeal, the billed code and description from the claim is to be included. If a specific contract supports your claim, provide a copy of the
portion of your contract which outlines the submitted billing.

Our process is simple and direct.

Every provider is afforded the opportunity to submit a dispute for review. It is ClaimReturn policy to provide an additional independent review of claims disputed by a provider. All valid appeals will receive a written response from the ClaimReturn Appeals Unit, to include an explanation of the secondary review findings. Technical denials are sent as notification that the claim remains in active collections.

All revised or corrected claims submitted will be handled as an appeal denied on a technical basis.  ClaimReturn is engaged by our clients to review previously paid medical claims to ensure adherence to, but not limited to, the following: the American Medical Association code definitions, the National Correct Coding Initiative edits, national and local policies, coding guidelines developed by national societies, and standard medical and surgical practices.

Every provider is limited to 1 appeal submission per case. ClaimReturn policy limits the Appeals Unit responses to 1 Technical Appeal and 1 Secondary Review Explanation per provider’s case. Providers who do not submit relevant documentation to support their appeal, or submit insufficient information, will receive a technical denial.

Important Dates

You must submit your appeal within 30 calendar days of receiving your Revised Explanation of Benefits from ClaimReturn. If an appeal is not received within this 30-day window, the provider will receive a technical denial advising that the case remains in active collections.

How do I get this information to you?

Enter your contact information and upload the submission documentation as referenced above via ClaimReturn’s Secure Appeals Portal. You can also fax your appeal to (844) 884-1308 or e-mail it to Appeals

The appeals form is password protected; the password is included at the bottom of the EOB you were sent.