 |
|
|
 |
Specialty-Specific Appeals: Demanding A Quality Review of Specialty Care Claims
Specialty care medical appeals often involve complex clinical information. Hours can be spent crafting a detailed explanation
regarding the treatment provided and current specialty care standards. We have developed a number of "appeal review demands"
which are particularly applicable in overturning specialty care denials.
Read this entire article... |
|
|
AppealLettersOnline Featured Letters
Appeal Solutions has a number of appeal letters which can be
easily customized for such specialty-care appeals. Please see the Topic:
Specialty Care Appeal Review. The following four letters have been added to AppealLettersOnline to assist with obstetrical-gynecological appeals:
1.
Request for Clinical Criteria - Ob-Gyn
2.
Request for Coding Criteria – Ob-Gyn
3.
Request for Ob-Gyn Peer Review
4.
Request for Coding Credentials – Ob-Gyn
These letters can easily be updated to reference a different
specialty care area. For assistance with adapting these letters to other
specialties, members can post their specialty
billing question in the forum area for their specialty.
Sign up to access these letters |
|
|
Specialty Care Appeals Training
We provide several customized specialty appeals training programs. Training involves a four-hour presentation to your
billing group on avoiding denials by demanding specialty peer review
and how to appeal denials by demanding a quality specialty care appeal review.
Special pricing is currently available for our orthopedic and
chiropractic specialty care training programs. The cost of the training
includes customized appeal letters for your organization which specifically
addresses the most frequently denied claims for your specialty. Training also
addresses stalled claims and responding to carrier stalls and delays.
Each training provides extensive information on state
utilization review laws and how they apply to verification and precertification
requests and related appeals. ERISA protections related to employee benefit
plans and claim processing protections which apply to specialty care claims are
also discussed. Participants may submit representative denials prior to the
training so that the presentation includes analysis of your organization’s
recent problematic denials.
Cost of the presentation is a flat rate of $4,000, inclusive of all travel expenses. However, orthopedic and chiropractic organizations which book training for June
or July qualify for a discounted rate of $3,200. Contact Tammy Tipton at 888-399-4925 or t.tipton@appealsolutions.com for information and to receive a list of
customized appeal letters which have been included in recent orthopedic and/or
chiropractic appeal presentations. |
|
|
|
|
|
