Lack of Medical Necessity

The appeals letter must be addressed to the following: Ms. Jane Doe, Claims Examiner, Division of Appeals, Suite 333 Plaza Managed Care Plan 555 Independence Court New York, NY 10012 Compose a properly formatted, block style letter to the third party representative indicated above. This letter should address the denial, state what documentation is attached to support the appeal you are making for denial of this claim and be worded in a professional manner. The letter should be typed using Times New Roman, size 12 font. You need to include the patient information in the letter and the claim number. You should also send this letter from you with your contact information and your title for Dr. Wang’s practice. Patient Information: Kevin Smith Date of Service: 5/17f2020 1708 Bedford Avenue [CD—10: K625 Brooklyn, NY 11234 Denied Procedure: Diagnostic Anoscopy DOB: 2/11f65 CPT Code: 46600 Insurance: Plaza Managed Care Plan Reason for Denial: Lack of Medical Necessity ID#: 5600128fGroup #: TLC5466 (Procedure not justified by diagnosis) Employer: Verizon Claim #: K33400999 Date of Denial: 6f15f2020 Provider Information I n -1:.r . I.”

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