Appeals Page (All Appeals View)
How to Access
Go to DME→ Appeals from the main sidebar.
Filters
In the Appeals Dashboard, you'll see the following filters:
Search bar – Quickly find appeals.
Filter by Date – Created, Submitted, Filing Deadline, Resolution Date. You can also pick a date.
Status - Pending, Submitted, Under Review, Approved, Partially Approved, Denied, Withdrawn, Escalated.
Appeal Type - Initial, Reconsideration, Second Level, Third Level, External, Other.
Outcome - Approved, Denied, Partially Approved, Pending
Organization
Overview
In the Appeals Dashboard, you'll see the following details:
Title
Files
Order
Type
Status
Outcome
Organization
Payer
Filing Deadline
Submitted
Add a new Appeal
Add Appeal – Click the “Add Appeal” button (top right) to create a new appeal.
Create Appeal Form - This will open the Create Appeal Form.
Complete the form and submit using the Create Appeal button at the end of the form.
Create Appeal Form Details
Practice - Select the practice from the dropdown list. You can use the search button to find the right practice.
Order - Select the order you with to appeal. The dropdown list will show you a list of orders under the practice you selected. It will show the patient name and order number. You can use the search button to find the right order.
Appeal Type - Select the appeal type (Initial, Reconsideration, Second Level, Third Level, External, or Other)
Status
Payer - Select the payer from the dropdown list. You can use the search button to find the right payer.
Outcome - Pending, Approved, Partially Approved, Denied
Appeal Title - Enter the appeal title
Appeal Reference Number - External Tracking Number
Appeal Reason Code - Standardized code for the appeal
Reason for Appeal - Explain why the appeal is being filed
Original Denial Reason - Please provide the details why the claim is originally denied
Outcome Details - Details of the appeal outcome
Submitted Date
Filing Deadline
Response Due Date
Response Received Date
Resolution Date
Notes
File Attachments - If needed. Can upload PDF, Images, and Word documents up to 20mb each file.
Appeals Tab under an Order
How to Access
Go to DME, Orders tab.
Find and select the order. You can use the search bar, or filter by status: Denied
Open the order's dashboard. In the dashboard, go to Appeals. This will show the Appeals Dashboard.
Add Appeal for the Order
Open the Create Appeal Form through the Add Appeal button.
Complete the form and submit using the Create Appeal button at the end of the form.
Create Appeal Form Details under the Order Tab
Appeal Type - Select the appeal type (Initial, Reconsideration, Second Level, Third Level, External, or Other)
Status
Payer - Select the payer from the dropdown list. You can use the search button to find the right payer.
Outcome - Pending, Approved, Partially Approved, Denied
Appeal Title - Enter the appeal title
Appeal Reference Number - External Tracking Number
Appeal Reason Code - Standardized code for the appeal
Reason for Appeal - Explain why the appeal is being filed
Original Denial Reason - Please provide the details why the claim is originally denied
Outcome Details - Details of the appeal outcome
Submitted Date
Filing Deadline
Response Due Date
Response Received Date
Resolution Date
Notes
File Attachments - If needed. Can upload PDF, Images, and Word documents up to 20mb each file.