Provider or Supplier Appeals When the Beneficiary is Deceased

210.1 - Provider or Supplier Appeals When the Beneficiary is Deceased (Rev. 695, Issued: 10-07-05; Effective: 05-01-05; Implementation: 01-09-06) When a provider or supplier appeals on behalf of a deceased beneficiary and the provider or supplier otherwise does not have the right to appeal, the MAC must determine whether another party is available to appeal by taking either of the following actions: • The MAC may send a letter to the last known address of the beneficiary, or to the beneficiary's estate, if known. The letter should advise the beneficiary's estate (or anyone taking responsibility for the deceased's bills for medical or other health services) of the right to appeal the claim denial. The letter also should provide information that the provider or supplier wishes to appeal. The letter should provide the beneficiary's estate with the following three options: o Option 1: I wish to appeal this claim. o Option 2: I am not available to appeal, please process the provider's appeal and let me know of the result. o Option 3: I am available to appeal, but do not wish to exercise my right to appeal. The MAC should allow the estate at least 10 days to respond, or the remainder of the time frame for requesting an appeal -- whichever is greater. If the estate does not respond in the allotted time frame, the MAC should annotate the file that no other party is available to appeal and continue to process the provider's or supplier's appeal. If the estate responds that it is available and wishes to appeal, the MAC should continue with the appeal and notify the provider or supplier of the results. If the estate indicates that it is not available to appeal, then the MAC should continue to process the appeal and notify the beneficiary's estate of the decision. If the estate indicates that it is available, but does not want to appeal, the MAC should dismiss the provider or supplier's request on the basis that there is another party available, even though the party does not intend to pursue the appeal; or The MAC may send a letter to the provider or supplier to request written confirmation that they are not aware of any other party available to appeal. The MAC should allow the provider or supplier 10 days to provide confirmation. If the MAC does not receive written confirmation within 15 days, it should dismiss the appeal on the basis that the provider or supplier did not confirm that there was no other party available to appeal.