Appeals Process

Despite the efforts to submit claims that are “clean,” denials, rejections, and partial payments will occur. When a facility receives a denial, rejection, or partial payment, a determination will need to be made regarding the action to be taken by the facility (accept the denial, rejection, or partial payment, resubmit the claim, or appeal).

For each reason in the table you downloaded, indicate the appropriate action (accept the denial, rejection, or partial payment, resubmit the claim, or appeal) and provide the rationale for your decision.