Managed Care Nursing

Category - Overview

What is the term for a physician or member submitting a written disagreement regarding a decision to deny or limit coverage, care, or service by the MCO?
  1. Denial
  2. Grievance
  3. Approval
  4. Authorization
  5. Appeal
Explanation
Answer: E - Appeal is the term used when a physician or member submits a written disagreement regarding a decision to deny or limit coverage, care or service by the MCO.
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