Some denied claims require a formal request for reconsideration or appeal. But this is not true of all claims that are not paid on the first submission. Sometimes, all that is required is submission of a corrected claim.

For example, a claim is submitted to a payer with appropriate codes for a COVID-19 vaccine product and its administration. The claim is denied. A business office staff member checks the payer’s payment policy for COVID-19 vaccine administration and learns that the payer requires submission of only the appropriate administration code (ie, no code for the vaccine product) appended with a modifier for state- supplied vaccine (SL). Following the payer’s guidance for submission of a corrected claim, the claim is resubmitted and payment is received. Had the staff member instead filed an appeal, the submission of a corrected claim may have been delayed pending review of the appeal or, in...

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