American Urological Association - Private Insurers

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Home Practice Resources Coding and Reimbursement Coding Resources and Information Private Insurers

Private Insurers

Nothing is more frustrating than submitting a claim for payment and having the claim denied. Whether the reason is as simple as an incorrect beneficiary name, inappropriate bundling or a question of medical necessity, this initial determination of a claim from the carrier is the bane of existence for many urologists' offices. It takes time and effort of the billing staff to determine if the determination was appropriate. In order to get these denied claims paid, there are certain appeals processes for both Medicare and commercial insurers which are different and must be followed.

Each private insurer has its own process in place for appealing denied claims. It is essential that your staff develop a protocol for appealing claims to each carrier. Most private insurers will have their appeals process provided either in writing to a provider's office or available on line. It is recommended that your staff collect the information on each private insurer your office is contracted with to establish how denied claims need to be appealed.

For more information on appeals, check out the links below:

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