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Recover Denied Claim Revenue and Collect What is Rightfully Due . . . Starting Today!

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SLIDESHOW: 5 Sentences to Improve Your Appeal LettersSLIDESHOW: 5 Sentences to Improve Your Appeal Letters
Do your carefully worded appeals result in simple form letter responses? If so, it is likely that your appeals may need more forceful language regarding carrier appeal review and response requirements. Getting the insurance carrier to provide a customized detailed response starts with making appeal letters more specific in regard to the appeal review and response requirements. . . . download >>

Seven Tips To A Successful Medical Necessity AppealSeven Tips To A Successful Medical Necessity Appeal has a number of letters citing state and federal disclosure laws which assist medical providers with demanding more complete information regarding denials. These letters are under the. . . .more >>

Denial Analysis Tactics to Improve Reimbursement
What gets studied gets improved. This is one of the simplest management concepts yet one of the most challenging when it comes to ambiguous data. What is understood gets improved is the more accurate maxim for analyzing the ambiguous. . . .more >>

Another Day in the Paradise of Managed Care ReimbursementAnother Day in the Paradise of Managed Care Reimbursement
It has happened again... another reimbursement check and Explanation of Benefits (EOB) has arrived from a Managed Care Organization (MCO) with an amount less than what you believe is due to you under your MCO agreement. What do you do now. . . .more >>

Increase Pay-up by Successfully Appealing Claim Denials
Increase Pay-up by Successfully Appealing Claim DenialsLearn why perseverance is the key to a high rate of overturned medical health insurance appeals. . . .more >>
Who’s following New PPACA Regulations and Who’s Grandfathered: Improve Verification Process by Seeking PPACA Status
Who’s following New PPACA Regulations and Who’s Grandfathered:  Improve Verification Process by Seeking PPACA StatusPPACA appeal review regulations have some important protections meant to achieve review transparency and insure impartial decision-making. However, understanding which plans and policies must follow the new rules may be confusing. Appeal Solutions explains some of the upcoming changes and suggests how to make the important distinction between who is following the newly developed PPACA appeal process and who isn't. . . .more >>
Bundling Denials Should Have Basis - Requesting Clarification
Bundling denials are highly problematic because various payors use different claim editing software to assess codes for compatibility. It becomes hard to determine why certain codes were bundled and what medical information might be persuasive in an appeal. . . .more >>
Demanding Fee Schedule Disclosure
Demanding Fee Schedule DisclosureWhen a claim appears to be underpaid, your appeal may need to seek disclosure of how the payment was calculated. . . .more >>
Drafting A Level I Appeal: Three Components of a Winning Appeal
Level I appeals need to be submitted timely. Medicare appeals must be filed within 120 days of the claim decision. Most commercial insurers require appeals within 180 days from the denial. These time constraints force medical providers into situations where . . . .more >>
Managed Care Contracts: AKA Mangled Care Contracts
Learn why mangled care can be an excellent system to be a part of, promote or profit from...if you're an insurance carrier. . . .more >>
Who's Reviewing Your Appeals? Man or Machine?
Who's Reviewing Your Appeals? Man or Machine?Appeals involve highly technical issues such as clinical guidelines, specialty coding standards, quality of care and contract requirements. It takes a highly qualified appeal reviewer to respond appropriately. However, carrier appeal responses fall short again and again. . . .more >>
Never Talk to the Monkey When the Organ Grinder is Available
Never Talk to the Monkey When the Organ Grinder is AvailableInsurance companies receive, review and uphold thousands of medical appeals each year. Should you be detered if you receive a letter stating your appeal letter was reviewed and the decision to deny payment was upheld. . . .more >>
CASE STUDY: Responding to Insurance Denials Due to Lack of Medical Necessity
CASE STUDY: Responding to Insurance Denials Due to Lack of Medical NecessityA 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 carrier’s policy definition of medical necessity. . . .more >>
Hospital Replaces Rebills With Appeals
Hospital Replaces Rebills With AppealsCASE STUDY: Rebilling unpaid claims at 60 to 90 days has long been a rule of thumb in medical receivables management. However, a California hospital has found a much more appealing method of handling aged claims that resulted in an immediate drop in aged accounts. . . .more >>
Insurance Recovery Requires Attitude
In appealing denied insurance claims, you need to have the mindset that it is the insurance carrier's burden to prove that the claim has been processed correctly and that any ambiguities in the coverage terms. . . .more >>
CASE STUDY: Appealing Denials Based on Verification of Preauthorization of Coverage
CASE STUDY: Appealing Denials Based on Verification of Preauthorization of CoverageAt the time of patient admission, the Provider called the Insurance Company to verify policy benefits. An insurance representative confirmed that coverage was currently in effect and provided coverage details. . . .more >>
Successful Denial Management Requires 2 Appeals
Most denials require two appeals for two reasons: first, insurance carriers do not always provide credentialed professionals for the initial review and second, insurance carriers often provide details in the Level I appeal response which may require further discussion. . . .more >>
A Day Late and a Dollar Short
Your business office missed the timely filing deadline by 30 days. The claim is filed and comes back denied. Now you have to make a decision - pursue the patient, write-off or appeal. . . .more >>
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"The service more than paid off. The first one I used had a yield of $19,700. It was a preauthorization issue. I used one of the appeal letters I purchased as the framework for the appeal I constructed. I have won quite a few utilizing the letters this way. They are a wonderful resource."

Mary W.

"My facility has been utilizing your service for almost two months. We are actually realizing payments on Managed Care denials that we would have otherwise written off. Also, for the first time, instead of us hunting the insurance companies for payment, the insurance companies are reaching out to contact us after receiving our letters. It's amazing the turnaround!"

Sheryl M.

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Agnes S.

"The content of the appeal letters really provides results, both in overturned claims and prompt responses from carriers. Some letters work better than others, depending on the denial reason, but they give us the means to appeal any type of denial and exercise our right to have denials reviewed and to be provided with proof to support their position."

Peggy A.

"In today's payer environment, we need to be armed with the most powerful weapon to look out for the rights of our doctors and get them reimbursed fairly for the work they have done. Appeal Solutions gives us that ammunition."

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Melissa G.

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Theresa D.

"I purchased the membership and wanted to tell you that I used one of the letters as suggested by you and was able to get the denial overturned. It was worth about $12,000."

Jolyn T.

"I never got a chance to let you know how much the letters helped me in collections. I was able to collect $98,000.00 on JUST ONE clinical trials case from an HMO case because of the ground work your company did. Your letters really do work. Such a great service and a great assistance to the patients who do not know the ins and outs of the Insurance juggernaut. INVALUABLE TO SAY THE LEAST!"

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Maria T.

"I just purchased your service and only being on it the very first time and in only 20 minutes, it is blowing my mind with all the information and tools you offer. I have racked my brain in some instances with these carriers and how to play their games. I have appealed, re-appealed, and even gotten suggestions from others on appeals. Your letters are law guided and I know will be more beneficial to us at work. I can't wait to share this new found information. I only purchased your product for one year as a trial basis in tracking increased reimbursement by using your letters; but I feel I will be extending this and/or upgrading before the year is out. Thank you so very much, and I am glad I was surfing today. I was at the end of my rope."

Debra M.