You can appeal insured claims that need to be adjusted or that have been cancelled.
If a claim was returned and was not paid, they have a billing item status of Cancelled.
Some claims are overpaid or underpaid. These have a billing item status of Paid.
You cannot make any changes to these claims but instead you can create and submit an appeal form to Medicare. You create this form directly from the billing item. This helps to generate a standardized format that includes a reason for the appeal.
⚠️ Important: Do not re-bill a claim unless instructed to do so by a Medicare assessor.
Steps
1. Open the claim either from the patient chart or the Billing dashboard.
2. In the Edit Insured Payment window, click the Prepare Appeals form (printer) icon.
📌 Note: The Prepare Appeals form (printer) icon only appears beside fee items that have a status of Paid or Cancelled.
3. In the PDF Settings window that opens, input information as follows:
Cover Page (optional): Select a cover page from the list to add to the appeal form. To learn more, go to Creating cover page templates.
Reason for Appeal: Type the reason.
📌 Note: The help text below Reason for Appeal assists you with what to include in your appeal.
4. Click Generate PDF.
A Medicare Claim Appeal Form PDF appears.
📌 Note: The provider’s name is included on the appeal form even if an MOA generates it. Additionally, a claim’s start time, if entered, is also included on the appeal form.
5. Fax the PDF to Medicare:
a. Click the fax button.
b. A new window appears, where you can specify the recipient.
c. If Medicare Appeals is stored in your Contacts, search for it and select, or manually type the fax number 902-838-0940.
d. Click Send.
📌 Note: The Medicare Appeals group processes your request, creates a report for each claim number, and sends it to your inbox.
Updated May 31, 2024