Overview
Appealing claims can be a complex process without the proper assistance. A successful appeal requires careful tracking of various pieces of information; this can involve documenting payer communication, status updates, appeal documents, appeal forms, and more. OneSpot offers a centralized solution for storing all appeal-related information, accompanied by various features to assist you in successfully navigating the appeal process. To begin the appeal process in OneSpot, the claim status must first be updated to 'Denied.' Please refer to the Deny article for detailed instructions on completing this step.
The below actions will generate an entry in the Activity tab within Claim Details and update the Last Worked date, ensuring a clear record of recent activity on the claim.
Accessing Denied Claims
1. Navigate to Aging > Claims.
2. Select the 'By Claim Status' filter, then, select 'Denied.'
3. Actions can be taken within the grid or the claim details.
a. Grid: Select the three dots to open the 'Work This Claim' action menu.
b. Claim Details: Select the row of the claim you want to take action on, then select 'Work This Claim' to open the action menu.
c. Claim Details - Appeals Tab: Select the row of the claim you want to take action on, then select the 'Appeals' tab.
File Appeal
1. Select 'File Appeal.'
2. Complete the following fields:
- Filing Date: This will default to the current date. If needed, this can be edited.
- Check on Appeal: This will default to 30 days from the current date. If needed, this can be edited.
- Upload Appeal Documents: If you have documents ready to be uploaded, you can select the 'Upload
- Appeal Documents' box. If not, you can unselect this box, and documents can be uploaded later.
- Comment: Enter a comment. This could include a more detailed reason for filing another appeal.
3. When finished, select 'Mark Claim as Under Appeal.' If you do not want to save the information, select 'Cancel.'
Note: If you selected the 'Upload Appeal Documents' box, continue to the next step. If finished, select 'Close.'
Upload Appeal Documents
1. Select 'Choose File,' then select a document from the dialogue window.
2. Select a 'Document Type' from the drop-down menu. If 'Other' is selected, the 'Document Summary' field will display and allow you to enter a more detailed description.
3. Select 'Upload Document' to finish uploading the document. Select 'Cancel' if you do not want to proceed with the upload.
4. When finished, select ‘Close. ’A success message will display to confirm that the document was uploaded. The document can now be downloaded selecting its name. The original appeals status will be updated to 'Upheld,' and a new appeal will be generated.