Category: Insurance | Difficulty: Intermediate | Priority: Nice-to-know
The plan's own review process in which it reconsiders a denial or adverse determination, often based on additional information submitted by the member or provider.
The first step where your insurance company reviews its own decision after you send an appeal.
[[appeal; adverse determination; external review]]
Plans must complete internal appeals within specific time frames for pre-service and post-service requests
🗂 Front Desk