Describe the basic steps in the appeals process for denied claims.

• A. Collect supporting documentation, prepare a concise appeal letter with codes and rationale, submit within filing limits, monitor status, and follow up as needed.
• B. Re-submit the claim without documentation.
• C. Wait passively for payer notice; no action required.
• D. Contact patient to request payment.

Answer: (D)

When a claim is denied, the essential step is to actively pursue a payer appeal using solid documentation and clear justification. Start by gathering everything that supports why the service should be covered—the denial notice, medical records, test results, prior authorizations, and any payer policy references. Then prepare a concise appeal that clearly identifies the denial reason, ties the service to the correct codes, and provides a solid rationale or policy citation to support coverage. Submit the appeal within the payer’s filing window and attach all supporting documentation to make a complete case. After submission, monitor the status, respond promptly to any requests for additional information, and follow up until a final determination is made. The other options don’t fit the appeals process: resubmitting without documentation won’t justify reversal, waiting passively misses the opportunity to overturn the denial, and contacting the patient to request payment falls under patient collections rather than the payer’s appeal process.