Since the utilization screens were lifted in Florida, not many chiropractors have to go through the appeals process.
Appeals are more relevant to the Medical Review process, where claims have already been paid and are being reviewed. The appeals process provides several levels you can take to obtain payment for a claim denial.
Besides unprocessable claims (discussed on the next page), the only other denial
you may receive is the "not payable for diagnosis" code, which denies
with the medical necessity message. For example, instead of a 239.4 you filed
a 239.1, which denies as being noncovered. You can either appeal the claim or
have it corrected. The easiest resolution is to call customer service and ask
to correct the diagnosis code. You may also submit the correct code in writing
to the appeals address. The Appeals Filing topic follows Unprocessable
Claims.