You will receive directions from the Quality Improvement Organization (QIO) regarding additional appeal options. The Quality Improvement Organization will respond to you as soon as possible, but no later than 14 days after receiving your request for a second review. ![]() Allow 15-days for electronic claims and 30 -days for paper claims before resubmitting. If filing electronically, be sure to also check your Availity® file acknowledgement and EBR for claim level failures. You may ask for this review immediately, but must ask within 60 days after the day the Quality Improvement Organization said no to your Level 1 Appeal. For claims status, use Availity® or contact Florida Blue. Within 48 hours the reviewers will tell you their decision. When you'll hear back from the Quality Improvement Organization (QIO) (Please refer to above directions regarding filing an expedited appeal) If you miss the deadline for contacting the Quality Improvement Organization about your appeal, you can make your appeal directly to us instead. You must contact the Quality Improvement Organization to start your appeal no later than noon of the day after you receive the written notice telling you when we will stop covering your care. You can ask to change this decision so you're able to continue coverage. TFL varies depending on the insurance company and also the type of insurance policy/plan. When your coverage for that care ends, we'll stop paying our share of the cost for your care. Timely filing limit refers to the period of time during which a healthcare provider or billing specialist must submit a claim for reimbursement to an insurance company. ![]() You’ll receive a "Notice of Medicare Non-Coverage (NOMNC)" in writing at least 2 days before we decide it’s time to stop covering your care. (Usually, this means you’re getting treatment for an illness or accident, or you're recovering from a major operation.) Rehabilitation care as an outpatient at a Medicare-approved Comprehensive Outpatient Rehabilitation Facility (CORF).Skilled nursing care as a patient in a skilled nursing facility.You have the right to keep getting your covered services for as long as the care is needed to diagnose and treat your illness or injury if you’re getting:
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