Greetings {ContactName|Appeal Letter Subscriber},
Using Disclosure Laws to Obtain Usual,
Reasonable & Customary Denial Information
UCR denials are often mired in mystery. What does
usual, reasonable and customary mean? How are the
reimbursement rates calculated? Are payers using
governmental entitlement program benefits as a basis for
calculating UCR? What proof has the payer collected
that actually demonstrates that the denied claim has been
billed at a rate above the norm. . .
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this article at AppealLettersOnline.com
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Repository has numerous state-specific letters citing
disclosure laws. These letters directly quote state
standards which require certain insurance plans to release
information regarding how policy or plan benefits are
calculated. There is also an ERISA letter which assists
providers appeal ERISA UCR denials by utilizing the ERISA
Advisory Opinion 96-14A.
Access the appeal letters at AppealLettersOnline.com
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