Casting Crowns Medical Group

2100 Grace Avenue

Long Beach, Ca 90802

Practice ID: 02-03459789

Date prepared: 5/15/2020EFT Number 8845162

Claim ID # 123456987412

Patient's NameDates of ServicePOProcQtyChargeAllowedPt.Amt Pd

From-ThruAmountAmountResp

Spencer David4/3/19-4/3/1922 99233-571$ 686.00$255.00$ 0.00 $ 0.00 B

Spencer David4/3/19- 4/3/1922475631$ 2550.00$ 1935.00$ 0.00 $ 0.00 B

Totals$ 3,236.00$ 2,190.00$ 0.00 $ 0.00

B- Denied for timely filing

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Please review they above EOB. Why was this claim not paid? What is your next step to receive payment?

You reviewed your billing software patient account, and notice that you show proof of timely filing. You submitted the above claim on 4/20/2019 and claim ID #

7412365874 is proof that the insurance company received the claim.You have decided to appeal the claim. Please upload your document to this assignment.

Write aprofessionalappeal letter to Casting Crowns Medical Group to request an appeal. Use Microsoft word to complete this assignment.