You are responsible for providing all of the information needed to support payment of your claims. The following information will assist you with the appeals process, and more specifically, provide clarification regarding the appropriate information to submit with appeal requests. There are instances that will require your office to submit supporting documentation at the time of your initial appeal request. Only you can decide which documentation best supports your claim. Please provide all relevant information and documentation at the time the initial appeal is requested, additional information will not be requested.
Below are some of the types of services you may appeal, as well as a list of medical records that may assist in supporting that the services billed are coverable by Medicare.
The following are examples of services for which you may be experiencing denials and are unclear of what documentation is needed when requesting an appeal. Many of the services on this list are associated with frequency parameters or diagnosis requirements. This list should be used as a guide to assist your office with the documentation required to process your appeal request as it relates to each of these specialties.
Documentation that would support the necessity of this testing includes, but is not limited to:
Other pertinent information (not an all-inclusive list):
Note: This information should be included when the original claim is submitted. If this information is not included, processing of your claim will be delayed or the claim will be denied.
Not all requests will require you to submit documentation such as hospital records, procedure reports, lab results, etc. A large majority of requests result from information that was omitted from the claim when it was originally submitted for processing. In those situations, a reopening may be requested and/or performed by the MAC to correct the omission or clerical error. Examples include (but are not limited to) the following:
National Government Services, Inc.
P.O. Box 6475 | Indianapolis, IN 46206-6475
National Government Services, Inc.
P.O. Box 7111 | Indianapolis, IN 46207-7111