Appeals

If you deny a treatment plan because you consider it inappropriate care for the patient, the provider can appeal your decision.

Note: The workflow to appeal a denied treatment plan is an add-on feature that is available at an extra cost. Contact your NantHealth Eviti account manager to implement this workflow.

The following steps describe the appeals process:

  1. The provider sends you appeal documentation, including the authorization request form and all supporting documentation.
  2. You review the documentation, complete the Eviti appeal form, and fax or email the appeal documentation to us.
  3. Our Eviti triage team assigns a physician to review the treatment plan under appeal. This physician is not the one who rejected the original treatment plan. The triage team attaches all of your documentation to the treatment plan and starts the appeal.
  4. The physician reviews the appeal documentation independent of the initial treatment plan review.
  5. After the physician completes the review, we notify you by email, and the treatment plan appears on the Appeals tab of your dashboard with a status of Pending Appeal. You see links to authorize or decline the treatment plan.
  6. You review the treatment plan and the documentation, and then authorize or decline the treatment plan.
    • If you authorize the treatment plan, the system assigns it an Eviti code, and moves it to the Eviti Code and All Records tabs. The status is Appeal Overturned, followed by the Eviti code, which means the denial was overturned.
    • If you decline the treatment plan, the system does not assign it an Eviti code, and moves it to the Code Denials and All Records tabs. The status is Appeal Upheld: Eviti Code Not Issued, which means the denial was upheld.