Ain't: If you do not agree with what we approved for these services, you may appeal our decision, To mean sure that we are bir to you, wa require another individual that did not process your initial chim to concust MADI the popeol. However In order to be eligible for an appeal, you must write to us within 120 days of the date you received this notice unless you have a good reason for being lite, Alert if you do not agree with this determin ton, you have the ready to appeal. You mat file a written MAOZ request for an appeal within 180 days of the date you receive this notice. This is a non-covered service because Iis a rodneypreventive exam or a ciagno lichcreening proceduen done in conjunction with a routine preventive exam. Usage: Refer to the 835 Healthcare Policy Identification