Appeals



Corrected Claims Process

Click Here for Electronic Corrections


Appeals Process:


Our new Appeals process, to better serve you, is to have all appeals in a standard format going to our new ClaimsChannel360 system.

In the past we've received hand written notes on EOBs, copies of medical notes without direction and other unclear requests. We have found that this air jordans 3 method is not effective and it delays the process and creates untimely filing issues. NYNM will no longer accept request for appeals in this manner.

As of December 5th 2011, ALL APPEALS and CORRECTED CLAIMS MUST GO TO THE NEW PO BOX:

NYNM IPA Appeals/COB
PO Box 640
Lake Katrine NY 12449


Your appeals MUST include the following or will not be processed and returned:

1. A NYNM APPEALS COVER SHEET
2. A valid reason and detailed description for appeal of a decision.
3. A copy of the claim (HCFA or print out from ClaimsChannel360)
4. Claim number if available*.
5. Supporting documents of proof for reconsideration of claim denial.


Types of Supporting Documents Include:
a. Authorization numbers/cover letters
b. Proof of timely submission
c. Copies of primary EOB
d. Medical Notes
e. Member eligibility proof (screenshots or other)
f. Member ID card copy
g. Copy of invoice(s)
h. Patient consent forms
i. Referrals
j. Corrected claim forms
k. Other