In the Implementation Guide, one of the business events supported for the request and response is certification appeal review request and associated response. In the guide it states this can be used by a requester to initiate the appeal of a denied or modified request for review. It also gives and example of a requester that is requesting an immediate appeal of previously denied or modified request. I am working with a group of payers and we have gone over this section but because of business practices an appeal will have to go to a special review board and it is most likely this will not happen immediately due to the information that needs to be taken into consideration for the appeal to be overturned. Then we were wondering if we were interpreted this section incorrectly. The question I have is how is everyone is interpreting the appeal process and the usage with the 278.
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