Latest updates: Appeals
Tutorial: Completing the Medicare Part A redetermination and clerical error reopening request form
Review our tutorial and learn how to correctly complete this form to ensure more accurate processing.
Changes to amount in controversy (AIC) for appeals in 2026
The claims value in dispute must meet the threshold for obtaining an administrative law judge (ALJ) hearing and a judicial review in federal district court. This is called the “amount in controversy…
Changes to amount in controversy (AIC) for appeals in 2026
The claims value in dispute must meet the threshold for obtaining an administrative law judge (ALJ) hearing and a judicial review in federal district court. This is called the “amount in controversy…
Appeal status requests must be obtained through SPOT
To enhance efficiency and ensure the secure handling of appeal information, all providers will be required to use SPOT to check appeal status and access duplicate appeal decision letters, effective…
Positron emission tomography (PET) for oncologic conditions: Modifier usage
The appeals department is receiving appeals regarding the incorrect usage of modifiers associated with PET scans. Read this article to learn more about billing these services correctly.
Claims and appeals for CPT 93010 performed in emergency room setting
Please review this article regarding appeals received for CPT 93010 (electrocardiogram report) and the use of modifier 77.