Appealing Denied Claims
Medicare
The most common reasons for GRAFTJACKET® Regenerative Tissue Matrix - Ulcer Repair product claims denials may include:

• Incorrect number of units reported
• Misspellings and transposed numbers
• Improper use of CPT® or HCPCS codes
• Payor unfamiliarity with GRAFTJACKET® Matrix products
• Inadequate description of products or services provided
• Restrictions on coverage settings or benefit contracts
• Delayed claim filing

In the event of a claim denial, be sure to resubmit the claim promptly as a corrected claim and with appropriate documentation. Well documented follow-up submissions are often successful. It is also important to determine the specific information required to resubmit the claim by speaking directly with the appropriate claims examiner and provider relations representative at the insurance company.

Many times, claims are denied because the claims examiner may be unfamiliar with the new therapy. Other times, the medical necessity of the therapy may not be readily apparent. When resubmitting a denied claim, it is helpful to include the following documentation:

• GRAFTJACKET® Matrix FDA Regulatory Classification and Indications
  The following documents are available to download:
  GRAFTJACKET® Matrix FDA Form (.pdf format)
  GRAFTJACKET® XPRESS Scaffold FDA Form (.pdf format)
  
• A letter of medical necessity
• A copy of the package insert
• Reprints of journal articles that support the efficacy of the GRAFTJACKET® Matrix used for the indication in question
• The AMA coding verification response letter

Reimbursement guide for Medicare, Private Insurance and Medicaid:

• Physician Office
• Hospital Outpatient Department (HOPD)
• Hospital Inpatient
• Ambulatory Surgical Center (ASC)