Doing a formal appeal is always the last step when working on a claim. Before filing an appeal, it is highly recommended that all other avenues be exhausted such as calling claims to determine why the claim denied, determine if a corrected claim needs to be submitted or reprocessing will take care of the issue, just to name a few. If it is determined that a formal appeal is needed, be sure to do it thoroughly and correctly as you may only have one chance; BCBS and Aetna only give one opportunity. Be sure to use the appropriate form provided by the plan. Clearly understand their process. Is this an administrative appeal or is it a clinical appeal? What is your window for filing the appeal? Don’t let it time out.
If you are in doubt of the process or how to work the claim, call your Managed Care Liaison for assistance, they will be glad to help!