The following article breaks down various to-do's you need to accomplish before you can send an appeal via email, explains how to email appeals via Rivet and offers templates you can use for emails and letters.
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To-do items before you can send an appeal email via Rivet
In order to send an appeal email through Rivet, you'll need to have email set up in Rivet.
To sync your email with Rivet, see this help article.
You can check if your email is set up in Rivet by doing the following:
1. Go to "account" under your practice dropdown at the top right of your Rivet screen.
2. Go to "communication" found in the list of options on the left side of your screen.
3. You'll see (on the right side of the screen) the email domain name (if you have Rivet's Estimates product you'll see two emails).
After you know that your email is set up in Rivet, you'll need to be sure your payer's contact information (i.e., email) is in the Rivet system.
Next, you'll need to encrypt the email to protect the PHI of your patients. An easy(ish) way to encrypt your email is with the help of your IT department. They can give you a secure word to put in the subject line that will automatically encrypt your email.
How to send email appeals via Rivet
1. Check all underpayments you'd like to send to a specific rep.
💡Pro-tip: Be sure to click on "select all (#) items" if you want to send all claims from a particular filter so that you can capture claims from multiple pages.
👉 Remember: Notes from the selected claims will appear on the CSV you'll send. Be sure to check that they are professional and add context to your appeal.
2. Click on the email button.
3. Click on submit.
4. Click on from and use the dropdown to find the correct email.
5. Copy, paste and edit our email template (found below) or create your own.
6. Be sure to use your encrypted secure word and your preferred subject line.
7. Leave the status toggle on if you'd like these claims moved to "sent" and send!
The parts in red need to be filled in based on your specific information.
Appeal Email Template
RE: Appeal of Comparison of Allowables for [ENTER COMPANY / PROVIDERS NAME]
[Your Company Information]
[Insurance Name]
[Contracted Plan Name / Fee schedule]
[Date of Service Timeframe]
[Total Variance Amount]
[Month Day, Year]
To Whom It May Concern,
After a thorough review of the terms agreed to in our contract, it has come to our attention that we have been underpaid. Our provider agreement with [INSURANCE NAME] states that we should be paid [ENTER TERMS] for [ENTER HERE THE FEE SCHEDULE (PLAN)], we are showing that the referenced claims were paid at [ENTER WHAT THE CLAIMS WERE PAID AT]. There is a total of [TOTAL NUMBER OF UNDERPAID LINES AND OR CLAIMS] and an outstanding variance amount of [THE VARIANCE TOTAL AMOUNT]. Attached is the detailed breakdown and support of the information we found.
This email and the attached documentation serve as notice of our objection to these payments and request for reprocessing. After reviewing all the information please get back to us with an expected date for reprocessing. If no further payment is to be made respond to this email with a copy of an applicable policy, referenced documentation in the provider manual, or explanation of how the obligated contractual terms were satisfied.
Sincerely,
Use the following template for letter-based appeals. Don't forget to print out the needed CSV from Rivet.
Appeal Letter Template
[Your Company Information]
[Insurance Name]
[Contracted Plan Name / Fee schedule]
[Date of Service Timeframe]
[Total Variance Amount]
RE: Appeal of Comparison of Allowables for [ENTER COMPANY / PROVIDERS NAME]
[Month Day, Year]
To Whom It May Concern,
After a thorough review of the terms agreed to in our contract, it has come to our attention that we have been underpaid. Our provider agreement with [INSURANCE NAME] states that we should be paid [ENTER TERMS] for [ENTER HERE THE FEE SCHEDULE (PLAN)], we are showing that the referenced claims were paid at [ENTER WHAT THE CLAIMS WERE PAID AT]. There is a total of [TOTAL NUMBER OF UNDERPAID LINES AND OR CLAIMS] and an outstanding variance amount of [THE VARIANCE TOTAL AMOUNT]. Attached is the detailed breakdown and support of the information we found.
This letter and the attached documentation serve as notice of our objection to these payments and request for reprocessing. After reviewing all the information please get back to us with an expected date for reprocessing. If no further payment is to be made respond to this letter with a copy of an applicable policy, referenced documentation in the provider manual, or explanation of how the obligated contractual terms were satisfied.
Sincerely,