Resources to Decrease Denied Medical Claims.
Home | Contact Us | Member Benefits | Search | Advertising | Member Area
 JOIN NOW
Become a member & get immediate access to all of our resources.
 SEARCH


Take a Free Tour
About ALO
 Who Should Join
 Download Samples
 Member Benefits
 Virtual Exhibit Hall
 Terms & Privacy Policy
 Take a Tour
 Member Comments
 Frequently Asked Qs
 Advertising
Discussion Forum
 MEMBER RESOURCES
 Appeal Letters
 Audio Conferences
 Discussion Forum
 Download Library
 Articles & Case Studies
 State Resources
 My Membership
 Virtual Exhibit Hall
 Help
 APPEAL TOPICS
 Providers' Rights
 Benefit Disclosure
 Utilization Management
 Medical Necessity
 Incorrect Payments
 Prompt Pay
 Treatment Excl/Limits
 Refund & Recoupments
 Specialty Care
 ERISA
 Medicare
 Contract Negotiation
 Other Topics
Visit our Online Store.
 Forum Topics
• Align Networks
• Nursing Home Appeal Due to Unsafe Discharge
• UCR and ACA State/Federal External Review
• Exception to Periodicity-Aetna
• Pre-Service Provider Appeals under Obamacare
• Deductible taken from non network provider payment
• Out of network benefits
• Out of Network - How much time to file appeal?
• Multiple Endoscopic Rule
• CPT 95941 UPDATE
• check tracer as a stall tactic. capitated facility
• No Prior authorization
• Two reductions listed on the Explanation of Benefits
• BCBS of ND Denial of Nerve Stimulator Implant..
• WC surgery was never billed from '09, claim is settled.








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

Join our community of thousands of medical office personnel who are decreasing their claim denial rates and increasing their reimbursement.

Find thousands of professionally written appeal letters, how-to articles and downloadable forms, checklists, manuals and other templates plus online seminars, audio programs, software and more resources. View some FREE Samples of our resources.

FEATURED RESOURCES
The 1000 Page Appeal Letter:  Covering the Clinical Bases In Experimental/Investigational AppealsThe 1000 Page Appeal Letter: Covering the Clinical Bases In Experimental/Investigational Appeals
When Attorney Jennifer Jaff appeals denied insurance claims, she uses boxes, not envelopes, for her appeals.

Her average appeal often consumes more than 50 record-gathering, research and development hours. When ready for the box, some appeals can cover more than 1,000 pages. . . .
more >>

Appeal Letter Access: Easy, Easy at AppealLettersOnline.comAppeal Letter Access: Easy, Easy at AppealLettersOnline.com
Appeal letters are now easier to find and use.

Most appeal letters require a very customized appeal. That is why AppealLettersOnline.com has more than 1600 letter options. However, frequent situations require medical billing professionals to appeal quickly with minimal denial detail.

AppealLettersOnline.com introduces our Level I - Level II Basic Appeal Letters to address. . . .
more >>

Denial Analysis Often Improves Healthcare ProfitabilityDenial Analysis Often Improves Healthcare Profitability
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, often uncharted, sea of denial data being generated in the initial stages of healthcare denial management. Read this entire article for information on implementing effective denial analysis within your organization. . . . more >>

Three Steps To Coding Appeal Success:  Improve Coding Appeals Now To Put Pressure On Payers To Divulge Coding EditsThree Steps To Coding Appeal Success: Improve Coding Appeals Now To Put Pressure On Payers To Divulge Coding Edits
Payer coding edits confuse and confound the most experienced coders. However, challenging a payer's coding determination often results in more confusion, more frustration and a single line of computer-generated insurer-speak such as "paid according to the plan or policy benefits."

Such explanations of benefits are little help and should be viewed as particularly unacceptable to those practices concerned about the upcoming ICD-10 implementation and the likelihood that payer coding edits may greatly impact reimbursement in 2014.

Now is the optimum time to increase your demands that payers. . . .
more >>

Seven Tips To A Successful Medical Necessity Appeal
Seven Tips To A Successful Medical Necessity AppealAppealLettersOnline.com 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 >>
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 >>
SLIDESHOW: 5 Sentences to Improve Your Appeal Letters
SLIDESHOW: 5 Sentences to Improve Your Appeal LettersDo 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. . . . 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 >>
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 >>
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 >>
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 >>
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 >>
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 >>
Another Day in the Paradise of Managed Care Reimbursement
Another Day in the Paradise of Managed Care ReimbursementIt 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 >>
More HeadlinesMore Headlines   

 MEMBER LOGIN
Username:
Password:


 
Sign in Problems?
 SAMPLE LETTERS

Download FREE
Sample Appeal Letters

E-mail:

 TESTIMONIALS
"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.


"I just want to say that this is the greatest reference to appeal letters that there can be!"

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."

Barbara C.


"I attended a Coding/Reimbursement seminar this past weekend in Las Vegas. During the conference I announced to the crowd that your service has saved us labor and precious revenue. I just wanted you to know that you have an effective service and our office has enjoyed the ease and rate of success we have enjoyed since we began using it."

Melissa G.


"I am a subscriber to your website and I absolutely love it."

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!"

Terri P.


"Your website has been very helpful! Worth twice the price!"

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.