The Appeal Letter

ISSUE 46 December 4, 2007

	Demanding Fee Schedule Disclosure Are your carriers forthcoming with fee schedule information? Incorrect payment appeals must be backed up with accurate fee schedule information. When a claim appears to be underpaid, your appeal may need to seek disclosure of how the payment was calculated... Read this entire article
	AppealLettersOnline Featured Letters Appeal Solutions has a letter citing the Fee Schedule Disclosure Demand referenced above. This letter is available under the Topic Benefit Reductions and Subcategory Miscellaneous. Further, we have developed a number of state-specific letters citing state Fee Schedule Disclosure Requirements. These letters are available under the Topic Benefit Reductions and Subcategory State Mandates. Sign up to access these appeal letters
	State Highlight California Fee Schedule Disclosure. The State of California has passed a number of managed care and insurance laws to require fair claims processing and appeal review. However, these protections may be ignored by the insurance carriers if not cited in your appeal letters. Appeal Solutions has prepared 20 state specific appeal letters which cite California claim processing and appeal review regulations. These letters are designed to assist you hold the insurance carriers to rigorous review and appeal response standards.
	Appeals Audioconference Appeal Solutions will conduct an audioconference presentation, Using Califonia law in Appeals, on December 11 at 11 a.m. PST. California-specific claim processing regulations and disclosure requirements will be discussed and instruction given on how to best use such legal information in utilization review and post treatment appeals as well as during contract negotiations. Speaker Tammy Tipton will explain how California law and regulations can be utilized by patient access and case management to assist with treatment approval. The 60-minute presentation will also discuss the appeal letter content and demanding the highest quality medical review at the insurance carrier. For more information or to participate in this audioconference, please call 888-399-4925 or click here for details.