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State of CaliforniaHealth and Human Services AgencyDepartment of Health Care ServicesWILL LIGHTHOUSE DIRECTORPROVIDER NAME ADDRESS 1 ADDRESS 2 CITY, STATE GAVIN NEWSOM GOVERNOR June 15, 2021, NPI
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Contact the appropriate department or agency that denied the submission
02
Request information on the reason for the denial
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Fill out Form 31167p42573resubmission with the corrected information
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Who needs 31167p42573resubmission of erroneously denied?
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Individuals or entities whose original submission was denied erroneously and need to resubmit with corrected information
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What is 31167p42573resubmission of erroneously denied?
It is the process of re-submitting a claim that was previously denied erroneously.
Who is required to file 31167p42573resubmission of erroneously denied?
Anyone whose claim was denied incorrectly must file the resubmission.
How to fill out 31167p42573resubmission of erroneously denied?
You need to review the denial reason, correct any errors, provide additional documentation if needed, and resubmit the claim.
What is the purpose of 31167p42573resubmission of erroneously denied?
The purpose is to ensure that legitimate claims are not wrongly denied and to give the claimant a chance to provide further evidence.
What information must be reported on 31167p42573resubmission of erroneously denied?
You must include the original claim details, the reason for the denial, any corrections or additional information, and any supporting documents.
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