The Appeal Letter

ISSUE 30 February 24, 2005

	Workers' Compensation Do you know the Five steps to successfully securing Workers' Compensation Payments? Find out here.
	Audioconference on Appeals Train your entire staff on appealing denied and incorrectly paid claims for only $197. Appeals – When “Limitations and Exclusions Apply” Isn’t Good Enough is a 90-minute audioconference featuring information on asserting your rights when insurers provide canned denials. Tammy Tipton, President of Appeal Solutions, will discuss what laws apply to appeal review and how to use them in your favor to obtain such pertinent details as the credentials of the reviewer and the documentation in the claim file or policy which support the denial. Over 96% of past attendees have said that their facility benefited from this audioconference and that they would be implementing several of the techniques and appeal letters presented during the audioconference. The live audio conference will be held Thursday March 31st at 11 a.m. CST. The audioconference is also available on CD-Rom. Click here for details... or call 888-399-4925.
	AppealLettersOnline.com New Topic AppealLettersOnline.com now features a new topic for workers compensation appeal letters. This topic will contain letters citing claim processing rules and regulations from each states’ workers compensation laws. Letters are being added to the repository over the next four months as follows: January: Prompt Payment of Medical Workers Compensation Claims for Alabama – Montana. February: Prompt Payment Appeals Specific to Workers Compensation Claims for Nebraska – Wyoming. March: Request for Review of Incorrect Payment for Workers Compensation Claims for Alabama – Montana. April: Request for Review of Incorrect Payment for Workers Compensation Claims for Nebraska – Wyoming. These letters are designed to assist providers with citing state laws in regards to unfairly delayed or reduced medical claims. Any questions or comments about how to best use these letters can be posted to the AppealLettersOnline.com Users Forum specific to Workers Compensation Claims.....sign up for access to the appeal letter repository
	Specialty Highlight: Some states, by statute or by regulation, limit the number of chiropractic visits that will be reimbursed under workers’ compensation. At least six states mandate limits on the number of chiropractic visits per case: California (24 visits), Florida (the lesser of 24 visits or 12 weeks of treatment), North Carolina (20 visits), Kansas (21 visits), Hawaii (30 visits over 180 days), and Alaska (46 visits over 1 year). However, the Alaska, California, Florida and North Carolina regulations permit approval of treatment beyond the standard number of visits if medically justified. We have added state-specific letters for these states citing the applicable mandate and appealing for treatment beyond the state mandated visit limitations based on medical documentation......sign up for access to the appeal letter repository
	State Highlight: New York Attorney General Eliot Spitzer has identified 21 New York health plans who have agreed to take action to ensure proper disclosure of "clinical review criteria," used by the health plans to determine coverage. In the past, health plans have sometimes failed to disclose these criteria and other essential coverage information, discouraging access to needed care, Spitzer stated in a recent press release. The New York Managed Care Consumer Bill of Rights requires health plans to disclose clinical criteria for coverage to both current and prospective enrollees upon written request. However, providers can seek disclosure of this information by submitting a valid assignment of benefits and citing applicable disclosure laws. See the AppealLettersOnline.com Appeal Repository Topic "Benefit Reductions" and the Subcategory "State Mandates" for those states, including New York, which have a benefit disclosure law governing release of such information. More information about the Attorney General’s efforts in regards to clinical review criteria disclosure is at www.oag.state.ny.us/press /2005/feb/feb10a_05.html