Responding to ADR dx dementia. Data submitted inconsistent. How to explain and reverse the denial of claim
Jan 5, '14
I'm not sure what you're asking, Ellen. Can you give more information?
Jan 6, '14
Maybe it's the VA's Alternative Dispute Resolution?
Not much you can do if the pt isn't hospice appropriate per FAST, PPS..
Jan 6, '14
I am not sure what they are disputing. If you have a physicians diagnosis of dementia, its hard to argue that the pt doesn't have it. If this is for nursing home care with a managed care org like Molina or united healthcare, are they disputing the level of care you are wanting? You probably need to talk to the insurance/company nurse reviewer and see what info he/she is needing so you can dispute the denial. Generally speaking the company will want documentation of some sort--H&P, discharge summary, nurses/progress notes, Dr's notes, MDS, lab work, etc... Hope this is what you talking about... if not, more complete information may get you better responses.
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