As part of their participation agreement, providers are required to submit all medical documentation to support the services billed on their claim. Providers must submit a complete medical record when requesting an appeal. The following is an alphabetical listing of types of services that you may request an appeal on. If you click on the type of service it will give you a comprehensive list of medical records that should accompany the appeal request for that type of service.

• Ambulance
• Ambulatory Surgery, Operating Room, Lithotripsy, Anesthesia, Recovery Room, Pre-Admission Testing
• Audiology
• Cardiac Rehabilitation
• Clinic/Therapeutic Services
• Demand Bill
• Diagnostic Studies
• Dialysis
• Education and Training
• Emergency Room
• EPO/ESRD Pharmacy
• Gastrointestinal Services
• HBO Therapy
• Inpatient Hospital / Hospital Ancillary
• Inpatient Procedure-W7018-OCE Edit
• IV Therapy
• Laboratory/Pathology Services
• Mammography
• Medical/Surgical Supplies and Devices
• Oncology, Therapeutic Radiology
• Pap Smear
• Pharmacy/Unclassified drug J3490
• Physical, Occupational, Speech and Respiratory Therapy
• Psychiatric Services, PHP, Alcohol and Drug Rehabilitation
• Pulmonary Rehabilitation
• SNF
• Treatment, Observation and Cast rooms
• UV-light