I'm writing in response to your letter of January 16,on behalf of *** *** of *** *** ***, AR concerning her desire for payment of a claim for dental services which was previously denied as a non-covered service.I've reviewed the records relating to this matterIt
appears that Ms*** office was misinformed regarding the benefits for which the involved patient was eligibleIt was a noncovered service, but this was not managed in a manner consistent with our processes or policy and the dental office and patient acted in good faith on inaccurate informationAvesis' policy and standard practice is to provide clear communications regarding members' covered services and to process claims and claims appeals, when they occur, in an accurate, timely mannerThis morning, our Claims Manager reprocessed the claim for this patient and approved it for payment. Ms*** dental office will be paid $for this service and the payment will be made next Wednesday during our weekly check runI called and spoke with Ms*** this afternoon and apologized for her frustration and the miscommunication that occurred in this instance, and advised her of the payment to be made in the next weekShe was very understanding and appreciative for the direct call to her office.I trust that this information will be helpful to you in responding to Ms*** complaint and I want to thank you for forwarding it to usPlease feel free to call on me if you have any additional questions regarding this matterMy office telephone number is ###-###-####, extension***. Thank you,*** ***Quality Assurance CoordinatorAvesis###-###-#### X ***
I'm writing in response to your letter of January 16,on behalf of *** *** of *** *** ***, AR concerning her desire for payment of a claim for dental services which was previously denied as a non-covered service.I've reviewed the records relating to this matterIt
appears that Ms*** office was misinformed regarding the benefits for which the involved patient was eligibleIt was a noncovered service, but this was not managed in a manner consistent with our processes or policy and the dental office and patient acted in good faith on inaccurate informationAvesis' policy and standard practice is to provide clear communications regarding members' covered services and to process claims and claims appeals, when they occur, in an accurate, timely mannerThis morning, our Claims Manager reprocessed the claim for this patient and approved it for payment. Ms*** dental office will be paid $for this service and the payment will be made next Wednesday during our weekly check runI called and spoke with Ms*** this afternoon and apologized for her frustration and the miscommunication that occurred in this instance, and advised her of the payment to be made in the next weekShe was very understanding and appreciative for the direct call to her office.I trust that this information will be helpful to you in responding to Ms*** complaint and I want to thank you for forwarding it to usPlease feel free to call on me if you have any additional questions regarding this matterMy office telephone number is ###-###-####, extension***. Thank you,*** ***Quality Assurance CoordinatorAvesis###-###-#### X ***