Geisinger Health Plan Request for Claim Reconsideration 2018 free printable template

PG:REQUEST FOR CLAIM Reconsideration#:This form and accompanying documentation MUST be submitted 60 days from the date on the Explanation of Payment (TOP). Retain a copy of reconsideration for your

How to fill out Geisinger Health Plan Request for Claim Reconsideration

How to fill out Geisinger Health Plan Request for Claim Reconsideration

1. Obtain the Geisinger Health Plan Request for Claim Reconsideration form from their website or your healthcare provider.
2. Fill in your personal information at the top of the form, including your full name, member ID, and contact information.
3. Clearly write the claim number for the claim you are requesting to be reconsidered.
4. Provide a detailed explanation of why you believe the claim should be reconsidered, including any relevant information that supports your case.
5. Include copies of any supporting documents, such as invoices, medical records, and previous communications regarding the claim.
6. Review the completed form for accuracy and completeness before submission.
7. Submit the form via the provided methods, such as mail, fax, or online submission.

Who needs Geisinger Health Plan Request for Claim Reconsideration?

1. Individuals who have received a denied claim or wish to appeal a decision made on their health insurance claims.
2. Patients or members of the Geisinger Health Plan seeking reimbursement for medical services or procedures.
3. Healthcare providers who need to appeal a decision made regarding a patient's claim.

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What is Geisinger Health Plan Request for Claim Reconsideration?

Geisinger Health Plan Request for Claim Reconsideration is a formal process through which providers or members can contest a claim decision made by Geisinger Health Plan, seeking a review and potential adjustment of the claim status.

Who is required to file Geisinger Health Plan Request for Claim Reconsideration?

Providers or healthcare practitioners who have received a denial or adverse decision on a claim submitted to Geisinger Health Plan are required to file a Request for Claim Reconsideration.

How to fill out Geisinger Health Plan Request for Claim Reconsideration?

To fill out the Geisinger Health Plan Request for Claim Reconsideration, complete the designated form with the necessary details including claim information, reason for reconsideration, and any supporting documentation, and submit it according to Geisinger's instructions.

What is the purpose of Geisinger Health Plan Request for Claim Reconsideration?

The purpose of the Geisinger Health Plan Request for Claim Reconsideration is to provide a mechanism for addressing and disputing claim denials, ensuring that providers and members have the opportunity to receive an accurate and fair evaluation of claims.

What information must be reported on Geisinger Health Plan Request for Claim Reconsideration?

The information that must be reported includes the patient's name, claim number, date of service, reason for the reconsideration request, details of the service provided, and any supporting documents that justify the appeal.