allowable days
Is the days allowed to appeal, usually from the date of the letter or the day the denial was received? I have reached out to our contracting Team to check that payer specific contract but was curious to what industry standard is. Thank you all for your help!
Comments
Typically it is the date on the letter. Keep in mind that some payers don't send the letters out timely. You may be able to reach out for an extension if the letter was not received timely.
In regards to the above and checking on the payer contract, I was curious to know how many CDIs know what their acute care hospital's contracts state in regards to the denial/appeal process?
We worked with business office to give us access to payor contracts, unfortunately there is no contract language specific to denials related to DRG downgrade due to clinical validation of diagnosis, 'conflicting,' sequencing rules.. etc..