2 news Disputing a payment or denial on a finalized claim If you disagree with a payment or denial on a finalized claim, we here at El Paso Health want to help you get the quickest possible resolution. Here are the steps you can follow, along with some helpful tips. Submitting a corrected claim. If your claim contains billing errors, submit a corrected claim using the appropriate resubmission code (6 or 7) and referencing the most recent claim number. You can find this number on your electronic remittance advice or in your Provider portal under claim details or reports. Providing the correct and most recent claim number ensures that your new submission appropriately replaces or corrects the previous one. Filing an appeal. If you continue to receive a denial or disagree with the payment after submitting a correction, you may initiate an appeal through our appeals and grievances process. A formal appeal requires a written letter, along with supporting documentation. Appeals can be submitted in person or via mail, fax, email, or phone. Two levels of appeal. If you disagree with the first-level resolution, you may submit a second-level appeal with new and additional supporting documentation to help our team reassess the dispute and work toward the best possible resolution. Further review. If, after the second-level appeal, you still have concerns about the outcome, we encourage you to reach out to our Call Center Representatives or your assigned Provider Relations Representative for further discussion and review. By following this process, we can ensure a more efficient resolution while minimizing duplication of efforts, ultimately leading to the best outcome for your office. Thank you for your partnership and commitment to providing quality care! Here we grow again! In October 2024, El Paso Children’s Hospital welcomed Xochitl CastilloRios, MD. Dr. Castillo-Rios is a pediatric nephrologist who, along with Ei Khin, MD, provides expert care to young patients with kidney problems. Muhammed Qureshi, MD, a seasoned pediatric cardiologist, joined the El Paso Children’s Hospital team in November 2024. He joins fellow pediatric cardiologists Jeffrey Schuster, MD, and Sudheer Gorla, MD. Together they will help grow the cardiology program to serve the El Paso community and beyond. In December 2024, after many years in private practice as the only pediatric neurologist in El Paso, Rodolfo FierroStevens, MD, joined the El Paso Children’s Hospital’s Multispecialty Center. He works closely with Ziyad Makoshi, MBBS, MSC, FRCSC, FAANS, and Alexandria (Allie) Melendez-Zaidi, MD, PhD, to care for pediatric neurology, epilepsy, and neurosurgery patients. El Paso Children’s Hospital hosted the Symposium on Endoscopic Surgery for Treatment of Craniosynostosis in November 2024. Neurosurgeons and oral and maxillofacial surgeons from around the world gathered to learn more about a minimally invasive approach to correcting craniosynostosis in young patients. The hospital also hosted the annual Southwest School Nurses Conference, in February of this year, where school nurses learned from our specialists how to care for students with special conditions. Stay tuned for more recruits and new services coming soon! Muhammed Qureshi, MD, Pediatric Cardiologist Xochitl Castillo-Rios, MD, Pediatric Nephrologist
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