Claims
Appeals
ArkCloud keeps the record of an appeal - which claim, which level, why, by when, and what happened. It does not send the appeal to the payer. You do that through the payer's own channel and record it here.
Written for: Billing and RCM teams
Record an appeal
ArkCloud RCM → Insurance → Appeals
- Create the appeal against the denied claim, with its level and reason.
- Set the deadline. If you leave it blank ArkCloud uses 60 days from today, which is a placeholder - use the payer's actual limit.
- The claim becomes Appealed and the appeal is dated as submitted today. Send the appeal to the payer yourself; ArkCloud has not sent anything.
Track it
| Field or control | What it means |
|---|---|
| Status | Pending, submitted, in review, approved, partial or denied - set by you as the payer responds. |
| Escalate | Only for an appeal recorded as denied, up to the fourth level (external review). Creates a new appeal at the next level with a new 60-day deadline, which also becomes the claim's appeal deadline; the denied appeal stays as it was. |
| Outcome | Recorded with an amount and notes. Recording an outcome posts no money: the payer's payment arrives on an 835 and is posted from there. |
| Who | Any internal staff role (Agent, Supervisor, Administrator). |