Creating an Appeal
Overview
Users can initiate an appeal in cases where a decision to deny a person's medical treatment is contested. The requestor of the appeal may be a provider, the person, or a representative of the person.
This Job Aid guides you through the steps to create an appeal against both a single service and multiple services for review at the same time.
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* Access to Utilization Management * Permission to edit requests * Permission to create an appeal
When a provider, person, or person representative formally requests a review of a previously denied request for services.
It is crucial to determine if the appeal being created is deemed urgent. An appeal is considered urgent when denied healthcare services are time-sensitive, potentially impacting patient’s health significantly if not provided promptly, such as in cases of emergency care.
Creating an Appeal for One Service
Start from the request view
Navigate to the **Services** section
On the service being appealed, click the three dots.
Click **Create Appeal.**
### Entering Requestor Information* Enter the **Requestor Name.** * Select the **Requestor Type.**(_Optional)_ Enter contact information for the requestor.
### Entering Appeals Details
If the denied service is time-sensitive and could potentially have an impact on the patient’s health, the status should be **Expedited**.
(_Optional)_ Change the **Urgency. Standard** is selected by default.* Select an **Appeal Process Type.** * Select a **Level of Appeal.**
The level of appeal is mapped to the chosen appeal process type. The level field does not enable until a process type is selected. The options available for the level is dependent on the selected process type.
* Select a **Type of Appeal.** * Enter a **Notified Date and Time** or select from the calendar picker. * Select a **Reason for Appeal**_(Optional)_ Fill in additional optional fields. The **All Documentation Received Date Time** is the date and time all supporting documentation is received.
Click **Save and go to Assessment.**
_(Alternate)_ Click **Cancel** to return to the request view without creating an appeal.
### Responding to the AssessmentAssessments have been configured by your organization to gather additional information in regards to the appeal. An appeal is not able to be submitted until the assessment is finalized.* Respond to all questions in the assessment. * Click **Finish.**
Click **Complete** to submit the assessment response and create the appeal.
(_Alternate)_ Click **Cancel** to return to the assessment to review responses or make changes.
The created appeal is displayed as a node under the service that it is associated with.
Creating an Appeal for Multiple Services
If multiple denied services are in the same request, an appeal for all can be created for them using a bulk action.
From the **Services** section, click on **Bulk Appeal.** .png>)
If the button is not enabled, the request does not have more than one denied services.
Select the checkbox next to each service to include in the appeal.
Click **Continue.**
Entering Requestor InformationFollow the steps forward from [Entering Requestor Information](https://app.gitbook.com/o/QKrAo4tPqIwpOmHDn0Lh/s/OINba0etwdCwLEV7naRO/~/changes/61/utilization-management-job-aids/appeals/creating-an-appeal/#entering-requestor-information) to create an appeal for all selected service.