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- Where should I send my appeal?
- Usually, your copy of the Explanation of Benefits (EOB) will have the address where appeals should be sent. If not, you can call the bill review company and obtain this address.
- How much of an underpayment should I appeal?
- That is a question your practice will have to evaluate. Our experience has shown that the more you appeal, the better work comp companies will pay you in the future. Appealing even the slightest underpayments, can reap benefits for future claims.
- What should I do if an appeal doesn't work?
- We have found that by including supporting documentation, quoting the OMFS, and including the actual fee schedule, the success rate of our appeals is quite high. However, sometimes carriers still refuse to follow the law and pay bills. In these cases we file liens as mandated by the work comp regulations. Additionally, appeals will only work if all services are authorized. Please see our "Billing Tips" for hints on making sure all visits and services are authorized.
- A code I use isn't working in the appeal generator. What do I do?
- Please email us at contact@claritymbr.com. We will research the code and see why it's not in our database. We will follow up with you as soon as we have a resolution.
- Does the appeal generator work for all dates of service?
- The appeal generator works for dates of service March 1, 2007 forward. If you have a date of service prior to March 1, 2007, email us for information on corresponding fee schedules. As rates change (such as for Durable Medical Equipment) the database is updated and automatically reflects the correct amount due per the OMFS based on the date of service entered.
- How long do I have to appeal a claim?
- The California Division of Workers' Compensation has outlined a statute of limitations of whichever is furthest away: 5 years from the date of service, 1 year from the last seen date OR 6 months from the case in chief.
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