Geisinger Health Plan Request for Claim Reconsideration 2014 free printable template

DME INITIAL RECERTIFICATION FORM PHONE: LOCAL: FAX: *DME VENDOR: *LOCATION: 866-248-1972 570-271-7127 570-271-7171 *PHONE: *GAP PROVIDER #: *FORM COMPLETED BY: *FAX: *MEMBER INFORMATION: *HEALTH PLAN

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 the Geisinger website or contact customer service.
2. Fill in your personal information, including your name, policy number, and contact information.
3. Provide details about the specific claim you are requesting reconsideration for, including the claim number and date of service.
4. Explain the reason for the reconsideration request clearly and concisely. Include any additional documentation that supports your case.
5. Sign and date the form to certify that the information provided is correct.
6. Submit the completed form along with any supporting documents via mail or fax as instructed on the form.

Who needs Geisinger Health Plan Request for Claim Reconsideration?

1. Patients who have had a claim denied by Geisinger Health Plan and believe it should be covered.
2. Healthcare providers seeking reimbursement for services rendered that were not paid by Geisinger Health Plan.
3. Members who want to dispute the processing of their claims due to errors or lack of communication.

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What is Geisinger Health Plan Request for Claim Reconsideration?

It is a formal process that allows healthcare providers and members to appeal a denied claim, seeking to have it reviewed and potentially overturned.

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

Typically, healthcare providers or policyholders who have had a claim denied by Geisinger Health Plan are required to file this request.

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

To fill out the request, you need to provide specific details such as the claim number, patient information, a clear explanation for the reconsideration, and any supporting documents.

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

The purpose is to provide an opportunity to review and potentially reverse a denial of payment for services rendered, ensuring that claims are fairly assessed.

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

Required information includes claim number, patient name, date of service, provider details, reason for reconsideration, and any necessary attachments that support the appeal.