Appeal to Humana - maximum allowable unit per day denial

Practice Address

Phone# 123-456-789

____________________________________________________________
20th Apr 2010

To
Humana
Attn: Appeals Department
PO BOX 14601
Lexington
KY – 40512

Dear Sir / Madam
Sub: Appeal of Medical claim
Attachments: Claim form, supporting Medical documents and denial EOB.
……………………

For patient X  (Service date: 02/20/2010) Humana denied this claim as "Maximum allowable unit per day, since for the same service there is a claim from a different doctor, that was paid,” claim# 388685142.

In this context we would like to inform you that the patient had developed left sided chest pain two weeks prior to Hospital admission and was also treated in ER. The cardiology group was called to consult the patient for chest pain and as a result of which patient has been diagnosed with pulmonary embolism. Dr.  did the respiratory consult for pulmonary embolism.

Since both Dr. name and Cardiology claims contain pulmonary embolism as the primary diagnosis Dr. name's claim has been denied as stated above. We have herewith appealed the claim with Consultation documents and CTA records for your reconsideration.

We request you to kindly have this claim re-processed and expedite reimbursement on this claim.

If you have any clarifications on this, please feel free to call us at 123-456-789

Thanks and Regards

Accounts Receivable – Reimbursement Specialist