In the world of billing insurance for acupuncture, payers improperly deny claims on the basis of medical necessity quite frequently. Sometimes such denials are a mistake, but all too often, these denials by insurers are intentional and intended to avoid coverage for treatments.
Because these persistent denials exist, it is important for you to understand how to fight a medical necessity denial in order for your patient to receive all of the coverage they are entitled.
Whenever an insurer issues a denial due to medical necessity, you can file an appeal with the insurer. Typically, you will need to provide a letter explaining why the denial was improper. It is important to include as much detail and evidence possible in the appeal letter.
Usually an appeal must be filed within 180 days of receiving the denial notice. In most states, insurers are required to determine the merits of an appeal to a claim denial within 45 days due to prompt payment laws.
As an acupuncture billing company here is the letter of medical necessity template we recommend for filing your appeal. LETTER
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