What is your process for handling claim denials?

Priority Health has a systematic approach to handling claim denials that focuses on clarity and resolution for its members. When a claim is denied, it typically begins with an explanation provided in the denial notice, which outlines the specific reasons for the denial. Common reasons may include a lack of medical necessity, issues related to eligibility, or coding errors. Members are encouraged to review the denial notice carefully to understand the rationale behind the decision. It is important for members to gather any necessary supporting documents, such as medical records or bills, that might help in appealing the denial. In many cases, Priority Health allows for an appeal process. Members can initiate this by submitting a written appeal, wherein they can explain why they believe the claim should be covered, referencing the specific details indicated in the denial notice. The appeals are usually reviewed by a team of professionals at Priority Health who will reconsider the claim based on the provided information and their policies. This process aims to ensure that claim decisions are fair and in line with the terms of the insurance plan. Members should be aware that there are time limits for submitting appeals and it is advisable to pay attention to those deadlines. For the most accurate and updated information, reviewing the specific details on the Priority Health website can be very helpful. This ensures that members have access to the latest guidelines and requirements related to claim denials and the appeal process.