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 >>
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 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 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 >>