Appeals will now be classified as pre-service and post-service, with their own standardized forms:
A narrative report is now also mandatory to accompany appeals. This as described by the NJ Department of Banking and Insurance as the, “explanation of the basis for the appeal.”
It is not just limited to medical necessity issues, but must be submitted for any/all appeals. Failure to do so will most likely result in the case not being accepted for the arbitration process.
“In addition, you should also consult with the revised DPRP of the individual carriers for further instruction, including separate fax numbers for Pre and Post Service appeals,” adds Mr. Shanton.
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4 points on hospital admission rates for ASCs in Q4
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