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What is the difference between an appeal of a claim and an adjustment of a claim?

April 26, 2017adjustment appeal claim

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What is the difference between an appeal of a claim and an adjustment of a claim?

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An appeal of a claim relates to denials due to late submission, a lack of medical necessity or lack of preauthorization of a service. This type of appeal is reviewed by the Provider Appeals Team, and as needed, a medical director.