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What's Covered and What's Not?  Partner With Your Patients to Demand Transparency

The latest AMA Insurer Report Card found that 19.3 percent of claims are paid incorrectly.

Can you figure out which ones are which?

Often, it takes too much time and too many demands to properly audit your payer's claim adjudication. . .

Continue reading this article at AppealLettersOnline.com

AppealLettersOnline.com Featured Appeal Letters

AppealLettersOnline.com has updated a number of state-specific appeal letters this month:

Hawaii Appeal Response
Hawaii External Review
Indiana Prompt Pay
Maryland Prompt Pay
Maine Workers Comp Prompt Pay
Maine Workers Comp Payment Inquiry
Michigan Request for Clinical Criteria
Montana Workers Comp Prompt Pay
 

Access the appeal letters at AppealLettersOnline.com

Using Utilization Review Laws to Appeal Denials and Obtain Quality Appeal Reviews

Appeal Solutions has developed an appeals training program specifically for utilization review personnel. Using Utilization Review Laws to Appeal Denials and Obtain Quality Appeal Review is a 90-minute presentation specific to state and federal utilization review laws. Tammy Tipton, President of Appeal Solutions, will discuss how to assert your rights when insurers deny medically necessary care. Level I and Level II utilization review appeal tactics will be discussed and legal protections related to specialty care peer review will be explained. Some of the appeal letters to be discussed include the following:

• Time frames for initial decision

• Time frames for appeal review

• Demanding specialty care and subspecialty care peer review

• Medical necessity laws and peer review disclosure requirements.

• Getting action on unnecessarily stalled decisions

• How To respond when precertification is not honored

Cost of the presentation varies and can be conducted via webinar or on-site with your utilization review personnel.  Sample appeal letters are part of the course material and can by customized for your specialty.  Please call Tammy Tipton at 888-399-4925 to schedule the presentation for your staff and discuss cost and format best suited to your needs.