Appealtraining.com

Appealing Coordination of Benefits Stalls And Denials

WebFlorida – Florida law prohibits the secondary from denying the claim based on the amount of benefits paid by the primary and requires the carriers to pay 100 percent …

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URL: https://appealtraining.com/appealing-coordination-of-benefits-stalls-and-denials/

CASE STUDY: Appealing Denials Based on Verification of …

WebRecent Articles. Medicare’s Slow Eradication of the “Improvement Coverage Standard” January 31, 2021 Successful Strategies for Avoiding “No New Information” …

Category: Health Go Health

Utilization Review Denials: Are Patients Abandoned or Offered

WebCarriers have a responsibility to provide detailed responses to utilization review requests. Further, when adverse determinations are given, many consumer …

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CASE STUDY: Responding to Insurance Denials Due to Lack of …

WebA medical provider has received an insurance denial due to lack of medical necessity. To review the correctness of this action, the provider’s office obtains the …

Category: Medical Go Health

Demanding Peer Review of Assistant Surgeon Denials

WebAppeals are often necessity to address the medical necessity of surgical assistants. To effectively appeals such denials is important to address the following in …

Category: Medical Go Health

How Will External Review Expansion Affect You

WebUnder the PPACA interim appeals regulation, health plans can require participants to exhaust internal appeals before seeking external review. Insurers are …

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Appealing Lack of Timely Filing After a MSP Denial

WebIf the group health plan denies for lack of timely filing, you may want to appeal this decision citing the limitation of the timely filing defense contained in Section 4632 of …

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Stopping Silent PPO Discounting: State Laws Recognize Silent PPO

WebA number of state laws now set limits on Silent PPOs and seek to protect providers from unfair and un-negotiated preferred provider discounting. Silent PPO …

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Using URAC To Curb Denials And Appeal Claims

WebThe American Accreditation Healthcare Commission/URAC has established rigorous standards for utilization review which many carriers must follow. The standards …

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Training Courses

WebEffective medical necessity appeals bring to the carrier’s attention necessary variations in care, emerging efficacy issues, and situations revealing flaws in the day-to-day clinical …

Category: Medical Go Health

Refund/Recoupment: Following The Money

WebThis letter may be customized for your organization to cite contract specifics applicable to coordination of benefits/subrogation. For more information about …

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Utilization Management

WebUtilization Management. A preapproved claim usually results in claim payment. Therefore, it is imperative that medical professionals demand a quality utilization review decision each …

Category: Medical Go Health

Lost Medical Records

WebSubmitting medical records to insurance carriers for medical review is a time consuming but unavoidable medical billing activity. Many insurance carriers require …

Category: Medical Go Health

The 60-Day Appeal Review Standard: Getting Carriers To Answer …

WebA 60-day appeal response deadline is common among many types of plans. The Medicare Appeals Process applicable to Fee for Service claims requires that First …

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Requesting Fee Schedule Renegotiation

WebAppeal Solutions has developed a Fee Schedule Renegotiation Request letter to easily initiate negotiations for fee schedule increases to offset ongoing investments in …

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