Single comment threadYou are looking at one branch of [Win] four denials, three appeals, one external review, approved — 16 comments in the full submission. View in context.
85
[Win] four denials, three appeals, one external review, approved
Something I noticed reading old threads that I have not seen said out loud. The advice on external review in this community changed substantially around the start of last year, and nobody went back and updated the older posts. So depending on which thread the search engine hands you, you get two contradictory answers…
it is in the wiki actually
Yeah, the denial code matters, it tells you what to fight.
Not to be pedantic but formulary and appeal are being used interchangeably and they are not interchangeable in real life.
The confident tone is doing a lot of work that the evidence is not.
Did you get step therapy or outright denial?
step therapy documentation is the weapon, use it