ATTN: PROVIDER APPEALS DEPT.
RE: Patient name
S.S.#
We are appealing your decision and request reconsideration of the attached claim, for the date of service 05/02/2007. We feel these charges were processed incorrectly by Gallagher Bassett. The same codes have been paid on dates of service before with a lower network adjustment.
Your prompt attention to this matter is greatly appreciated. If you have any questions regarding this matter or need any assistance, you may contact our office’s billing department (ph #) Monday-Friday, 8:00 a.m. – 5:00 p.m.
Sincerely,
AR specialist
Billing
