Resources to Decrease Denied Medical Claims.
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Home | Specialty Care

Appeal Topics
Specialty Care

We have a number of specialty-specific medical appeal letters to assist our specialty care clients with appeals related to their specific practice areas. These letters focus on demanding peer-to-peer reviews and release of clinical review criteria applicable to specialty care. There is also a letter specific to each specialty which seeks to have coding denials reviewed by a credentialed coder with familiarity with specialty coding.

Topic Areas for Specialty Care:

Specialty Care Appeals
Specialty treatment is growing in complexity and specialty care appeals often detail complex clinical information. It is important to demand a quality appeal review with appropriately credentialed personnel. Our appeal tips for specialty care appeals will assist with improving such appeals. . . .more >>

Alternative/Complementary Care
Appeals related to alternative/complementary care often require knowledge of the policy or plan benefits. Find out how to effectively obtain information regarding alternative/complementary limitation and exclusions. . . .more >>

Mental Health
Mental health appeals can be made stronger by citing both state and federal mental health benefit parity laws. See our tips and appeal letters for improving mental health appeals. . . .more >>

Emergency Care
Emergency care reimbursement has a number of legal protections, from prudent layperson definitions to state requirements regarding out of network benefit calculations. However, compliance with these laws often require well worded appeal letters. more >>

Keep updated on how to use legal protections in ob-gyn-related appeals including citing the Newborns’ and Mothers’ Health Protection Act of 1996 and numerous state laws such as direct access to ob-gyn care. . . .more >>