Denial Management & Appeals

Payers deny Spravato claims frequently due to strict documentation rules, prior authorization details, or coding errors. Resolving these denials requires quick action and detailed documentation. Delayed appeals often lead to permanent write-offs.

Our team reviews denied claims to identify the root cause. We resolve coding and documentation issues to secure reimbursement.

The Appeal Process

We review the Explanation of Benefits (EOB) to determine why the payer denied the claim. If the denial is due to a prior authorization issue, we compile clinical evidence to prove the patient meets the medical necessity criteria. We write custom appeal letters that reference the patient’s medical history and the FDA-approved guidelines. If a peer-to-peer review is necessary, we prepare the documentation for your physician to facilitate a successful call.