Claim Rejections

Requests for additional Information

Rejection: Requests for additional Information Documentation-Requests for additional supporting documentation. Examples: certification, x-ray, notes.Supporting documentation.

What happened: Additional documentation is required for the processing of the claim. The specific type of documentation is listed on the following message.

Resolution: Add the requested document via the attachment tool. The request will remain open for 15 days. If no document is sent within that time, the claim will receive a rejection response. Instructions on utilizing the attachment tool can be found here: https://cms.officeally.com/OfficeAlly/Forms/Forms/NonWC_Attachment%20Tool_20150421.pdf?and here: https://cms.officeally.com/OfficeAlly/Forms/Forms/Workers_Comp_Attachment_Instructions_20150507.pdf