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Provider Communicator Summer 2018

Appeal of a Denial

This is a newsletter article. The information may not be up-to-date. If you have questions, please contact your Provider Coordinator.

Follow These Steps to Appeal a Den​ied Claim

Quartz is seeing an increase of the number of providers that simply send medical records with no correct claim information and and no explanation as to why the records are being sent. It is likely that the providers are requesting an appeal of a denied claim.  To make sure your appeal is handled in a timely fashion, please follow these steps –

  1. Complete the Claim Adjustment/Review Request Form
  2. Provide supporting documentation that explains what action they expect from Quartz.  Examples include: “Reconsider bundle denial based on supporting documentation”.
  3. Provide documentation to substantiate the need to reconsider the original denial.

When this information is provided, Quartz will review the case and determine if the original denial can be overturned. 

For those records that have already been submitted without the Claim Adjustment Form or ​Explanation: the records have been scanned and filed under the member number (available). No processing will occur until the Form and ​Explanation ​are provided.

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Don't miss the next issue!

Changes to the ICD-10 diagnosis codes for 2019 will go into effect on October 1st.

Nearly 300 new codes have been created, from codes that address current social issues to codes that more accurately describe surgical wound location and depth.

Look for “Coding Alert” the Fall Quartz Communicator (September) for an exploration of these new codes and what they mean for your facility.