Appeals and Denied Claims Management

Pre and post claims review can lead to the denial of payment to the provider.

In these instances, the provider needs to determine if the claim substantiates and qualifies for payment. If so, the appeals process begins. Harmony Healthcare International,  Inc. (HHI) can help from the redetermination to the judicial review level.

Additional Development Request (ADR)

  • Level 1: Redetermination
  • Level 2: Reconsideration
  • Level 3: ALJ Hearing
  • Level 4: Medical Appeals – Council Review
  • Level 5: Judicial Review

How can Harmony Healthcare International, Inc. (HHI) help?

Our services include:

  • Determine if the denied claim has justification for redetermination
  • Develop a tracking system for timely submission
  • Assist in coordinating the medical record documentation collection process
  • Prepare claim specific redetermination letters
  • Identify potential causative factors related to the claim denials
  • Review claims for completeness prior to submission to the review agency
  • Claim reviews may be completed On-site and/or Off Site  
  • Identification of prevention strategies 
  • Education of prevention strategies
  • Executive summary of findings (may include qualifier grid)

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