Description of Request: Appeal form for Medi-Cal (State of CA Medicaid). Separate area (similar to Batch Payment Posting) for sending Appeals to an insurance company. This should include the Appeal form template from Medi-Cal or any Mail Merge document created by the practice.

Requested Steps to define spec:

1. Billing menu
2. Appeal Module (to send an appeal letter for any outstanding claims)
3. Search for Patient by Name, Account Number, or DOB (similar to Batch Payment Posting)
4. Select Sequence(s) to send appeal (up to 14 dates of services)
5. Select (5) Claim Type (01 Pharmacy, 02 LTC, 03 Hospital Inpatient, 04 Hospital Outpatient/Clinic, 05 Physician/Allied, 07 Vision)
6. Select (9) Delete (if needed)
7. Enter (10) Claim Control No. for each Date of service
8. Enter (12) EOB/RA code for each Date of Service
9. Enter (13) Reason for Appeal
10. Select (14) Common Appeal Reason

Expected Result:
Box (3) Provider Name/Address, (4) Provider No. (Provider/Practice Ins No.), (7) Patient Name, (8) Patient’s Medi-Cal No. (Policy #) to auto-populate based on Plan Set from sequence
Boxes (5), (9), (10), (12), (13), (14) to allow user to manually enter data.
All data entered should print on the Appeal form provided by Medi-Cal in the correct fields. For other insurance plans, user will select the mail merge document created by practice.
Current Result:

N/A

Impact on Workflow:

High, this can speed up the Appeals process for the client. They will not have to type information individually onto each form using the typewriter.