- Tips for Success
- Tips for Success
- Phonetic Alphabet
- Phonetic Alphabet
- Using Touch-Tone
- Using Touch-Tone
- Main Menu Options
- Main Menu Options
- Fast Track Access
- Fast Track Access
- Eligibility <1>
- Eligibility <1>
- Claim Status <2>
- Claim Status <2>
- Checks <3>
- Checks <3>
- Offsets <4>
- Remittance Statements <4>
- Pricing <5>
- Provider Enrollment <6>
- Provider Enrollment <5>
- Patient Status <6>
- Appeal Status <7>
- Appeals <7>
- General Information <8>
- General Information <8>
- Other Options <9>
Appeals <7>
When the Appeals option is selected, the IVR will request and collect the following elements:
Provider authentication elements:
- NPI
- PTAN
- TIN
- Note: If NPI, PTAN, TIN was already provided for another option on the same call, you will not be prompted for this information again.
Beneficiary authentication elements:
- HICN or MBI
- Refer to the Phonetic Alphabet for assistance with speaking alpha characters
- Beneficiary name
- Beneficiary date of birth
- Note: If the beneficiary’s HICN or MBI, name and date of birth were already provided from a previous transaction, the system will not prompt you to repeat this information.
Claim information:
- Claim number for which the Appeal was submitted for.
- CCN (optional)
- Note: If you do not have the CCN for your appeal, simply say “I don’t know it.”
Once the authentication elements have been verified, the IVR will supply the following:
- CCN
- Date appeal request was received
- Status of appeal: The description in bold will be played back for appeals in a final or pending status, the description that follows will not be read on the IVR but is provided for additional clarification:
- Final
- Additional Payment – Redetermination: This message indicates your Appeal was favorable and will result in an additional payment being made.
- Affirmation and/or Overpayment: This message indicates your Appeal was unfavorable and a refund for the previously made payment should be sent to Medicare.
- Additional Payment – Reopening: This message indicates your Appeal was favorable and will result in an additional payment being made.
- Dismissal due to timeliness or incomplete: This message indicates your Appeal was dismissed due to being outside of the 120-day appeals timeframe or due to being incomplete. Your dismissal letter will provide additional information.
- Dismissal by Appeals – For additional information, please contact the Provider Contact Center: This message indicates your Appeal was dismissed. There can be many factors, please contact us or review your dismissal letter for additional information.
- History Correction – Reopening: This message indicates a favorable outcome on your appeal, however no additional payment was made.
- Overpayment – Reopening: This message indicates your Appeal was unfavorable and a refund for the previously made payment should be sent to Medicare.
- Delete – For additional information, please contact the Provider Contact Center: This message indicates your Appeal was deleted. There can be many factors that would result in your Appeal being deleted, please contact us for additional information.
- Pending
- Pending: Review can take up to 60 days to complete.
- Appeals resolution date: This date represents the date the case was closed. A date will only be played back for cases in a Final status.
- Claim number
- Adjustment claim number: Will only be played back if your appeal results in an adjusted claim.
- Final
Appeals Navigation
| Voice | Touch‐Tone Entry |
|---|---|
| Repeat | # |
| Next CCN | 2 |
| Previous CCN | 3 |
| Change Claim Number | 4 |
| Change Medicare Number | 5 |
| Change NPI | 6 |
| Help | * |