Appeals Decision Correspondence

Decision Type of Correspondence
Full Reversal (Fully Favorable) A new Remittance Advice (RA) and payment will be issued
Partial Reversal (Partially Favorable) A new RA is sent and a letter mailed to appellant or representative detailing the decision and further appeal rights. All parties to appeal are copied on the decision. An adjustment is also performed with additional monies issued
Affirmation (Unfavorable) A letter is sent to appellant or representative detailing decision and further appeal rights. All parties to appeal are copied on the decision. No additional coverage can be allowed

 

Last Updated Jul 27, 2018