Appeal Services

If the patient's insurance company denies coverage, the case manager will coordinate an appeal of the denial. Appeal letters are customized to include the patient's specific diagnosis, medical history and clinical documentation proving the medical need for the prescribed treatment. As with the prior authorization process, either the provider or the case manager may submit the appeal packet to the payer. The case manager conducts follow-up and reports outcomes as appropriate. RxCrossroads will work closely with your organizations Managed Care staff to relay policy and coverage information individual payers. This tracking mechanism allows us to provide immediate feedback to your organization when denials are received unexpectedly.