What services are included under Denied/Underpaid Claims and Appeals Assistance?
Researching denied or under-reimbursed claims is an important check to ensure that payers cover all appropriate benefits allowed under a plan. At the request of a patient or healthcare professional, the GSKRRC can assist by providing the following services: • obtaining copies of applicable claims, explanation of benefits, appeals judgments, and other relevant documentation for review • thoroughly reviewing claim, EOB, and/or contacting the insurer (if necessary) to determine the reason for the denial or underpayment; • advising the patient or healthcare professional why the claim was denied or underpaid; • advising the patient or healthcare provider of the corrective measures needed, if any, to obtain appropriate coverage or payment as directed by the patient’s insurer. • providing limited assistance with appeals for oncology products as appropriate; and, • communicating outcome of appeals request back to prescriber and/or patient.
