What Is Appeal?
A formal request by an insured or provider to reconsider an insurer's decision, such as a claim denial or coverage determination. Appeals typically follow a staged process with internal and external review options.
Appeal across 2 exams
Appeal appears on the following exams. Each defines it in the context candidates are tested on:
- Health Insurance
- A formal request by an insured or provider to reconsider an insurer's decision, such as a claim denial or coverage determination. Appeals typically follow a staged process with internal and external review options.
- CBCS (NHA)
- A formal request submitted to an insurance company or government payer to reconsider a claim denial or dispute the reimbursement amount. Appeals must include supporting documentation and must typically be filed within a specified time window.