Appeal vs Reconsideration

A reconsideration is a request for the payer to re-review the original claim with no new information (often automated, takes 7 to 30 days). An appeal is a formal request with new documentation, clinical justification, or medical records (45 to 90 days). Most payers offer multiple appeal levels: first level (administrative), second level (medical director), third level (independent external review). File reconsiderations first when the denial appears to be a payer error; file formal appeals when documentation supports overturn.