Sample Letters of Appeal

Administrative

  • Generic Appeal
  • Inadvertent coding error by practice
  • Claims underpayment
  • Lack of Recognition of CPT modifier 25
  • Lack of Recognition of CPT modifier 59

Medical Necessity

  • Pre-Appeal requesting add’t information
  • Letter to Health Plan-Option A
  • Letter to Health Plan-Option B
  • Letter to Health Plan-Option C
  • Patient Letter Notification of Appeal

Prompt Payment

  • Letter to Health Plan regarding late payment
  • Letter to State insurance commissioner or other entity that regulates health payers
  • Letter to patient’s employer or health plan
  • Letter to Health Plan regarding late payment of claims in violation of the practice’s contract
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