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Denied Claims

The Appeals Process for Denied Claims: What to Do

The Affordable Care Act (ACA) gives everyone the right to ask insurers to reconsider a denied claim or appeal their decision. When a health plan conducts a review of an appealed claim, the process is referred to as an "internal appeal." In the event that the plan denies the appeal, the ACA allows for an independent review organization to conduct an "external review" and either uphold the health plan's decision or overturn it. [40]

How to Appeal a Denied Claim

Before beginning a formal appeal process, you should first do the following:

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Please note that this website is provided for informational purposes only and is not intended to serve as comprehensive training on medical billing and coding. Additional training on medical coding may be required. The information on this website is believed to be accurate as of the date of publication. Users should independently verify accuracy.

Healthcare providers are responsible for making the ultimate decision on when to use a specific product based on clinical recommendations and how to bill for products and related services rendered. Consult third-party insurers' guidelines for specific information regarding the billing and reporting of services rendered.

You are encouraged to report vaccine adverse events to the US Department of Health and Human Services.
Visit to file a report, or call 1-800-822-7967.

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