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Who Should Join Download Samples Member Benefits Terms & Privacy Policy Take a Tour Member Comments Frequently Asked Qs Advertising Appeal Letters  Media & Downloads -- Audio Conferences Discussion Forum Download Library Articles & Case Studies State Resources My Membership Virtual Exhibit Hall Help Providers' Rights Benefit Disclosure Utilization Management Medical Necessity Incorrect Payments Prompt Pay Treatment Excl/Limits Refund & Recoupments Specialty Care ERISA Medicare Contract Negotiation Other Topics • Viant -- Poor Payer • Horizon BCBS • EXPERIMENTAL INVESTIGATIONAL • Humana denying nail debridements when other services rendere • UBH MNRP - SUBSTANCE ABUSE REV CODES • UBH substance abuse denial due to rendering provider issue • Ambulatory Surgery Center Start Date • Denial based on facility Accrediation in CA • AUTOMATIC RECOUPMENT-HEALTHPLUS AMERIGROUP • LA CARE DENIALS • Medicare denial - referring MD not eligible to refer for ser • Federal BC pay provider • Pay the member • GEHA - DENIED NOT MEDICALY NEC. • aetna denying anesthesia 1600 Appeal Letter Templates Used By 4000 Healthcare Organizations to: Improve Cash Flow! Minimize Claim Denials! Reduce Write-Offs! Thousands of appeal letter templates, how-to articles, online seminars, audio programs, software and more. View FREE Appeal Letter Samples. The 1000 Page Appeal Letter: Covering the Clinical Bases In Experimental/Investigational Appeals When Attorney Jennifer Jaff appeals denied insurance claims, she uses boxes, not envelopes, for her appeals. Her average appeal often consumes more than 50 record-gathering, research and development hours. When ready for the box, some appeals can cover more than 1,000 pages. . . . more >> Appeal Letter Access: Easy, Easy at AppealLettersOnline.com Appeal letters are now easier to find and use. Most appeal letters require a very customized appeal. That is why AppealLettersOnline.com has more than 1600 letter options. However, frequent situations require medical billing professionals to appeal quickly with minimal denial detail. AppealLettersOnline.com introduces our Level I - Level II Basic Appeal Letters to address. . . . more >> Denial Analysis Often Improves Healthcare Profitability What gets studied gets improved. This is one of the simplest management concepts yet one of the most challenging when it comes to ambiguous data. "What is understood gets improved" is the more accurate maxim for analyzing the ambiguous, often uncharted, sea of denial data being generated in the initial stages of healthcare denial management. Read this entire article for information on implementing effective denial analysis within your organization. . . . more >> Three Steps To Coding Appeal Success: Improve Coding Appeals Now To Put Pressure On Payers To Divulge Coding Edits Payer coding edits confuse and confound the most experienced coders. However, challenging a payer's coding determination often results in more confusion, more frustration and a single line of computer-generated insurer-speak such as "paid according to the plan or policy benefits." Such explanations of benefits are little help and should be viewed as particularly unacceptable to those practices concerned about the upcoming ICD-10 implementation and the likelihood that payer coding edits may greatly impact reimbursement in 2014. Now is the optimum time to increase your demands that payers. . . . more >> Seven Tips To A Successful Medical Necessity Appeal AppealLettersOnline.com has a number of letters citing state and federal disclosure laws which assist medical providers with demanding more complete information regarding denials. These letters are under the. . . . more >> Who’s following New PPACA Regulations and Who’s Grandfathered: Improve Verification Process by Seeking PPACA Status PPACA appeal review regulations have some important protections meant to achieve review transparency and insure impartial decision-making. However, understanding which plans and policies must follow the new rules may be confusing. Appeal Solutions explains some of the upcoming changes and suggests how to make the important distinction between who is following the newly developed PPACA appeal process and who isn't. . . . more >> SLIDESHOW: 5 Sentences to Improve Your Appeal Letters Do your carefully worded appeals result in simple form letter responses? If so, it is likely that your appeals may need more forceful language regarding carrier appeal review and response requirements. Getting the insurance carrier to provide a customized detailed response starts with making appeal letters more specific in regard to the appeal review and response requirements. . . . more >> Demanding Fee Schedule Disclosure When a claim appears to be underpaid, your appeal may need to seek disclosure of how the payment was calculated. . . . more >> Drafting A Level I Appeal: Three Components of a Winning Appeal Level I appeals need to be submitted timely. Medicare appeals must be filed within 120 days of the claim decision. Most commercial insurers require appeals within 180 days from the denial. These time constraints force medical providers into situations where . . . . more >> Managed Care Contracts: AKA Mangled Care Contracts Learn why mangled care can be an excellent system to be a part of, promote or profit from...if you're an insurance carrier. . . . more >> Who's Reviewing Your Appeals? Man or Machine? Appeals involve highly technical issues such as clinical guidelines, specialty coding standards, quality of care and contract requirements. It takes a highly qualified appeal reviewer to respond appropriately. However, carrier appeal responses fall short again and again. . . . more >> Denial Analysis Tactics to Improve Reimbursement What gets studied gets improved. This is one of the simplest management concepts yet one of the most challenging when it comes to ambiguous data. What is understood gets improved is the more accurate maxim for analyzing the ambiguous. . . . more >> CASE STUDY: Responding to Insurance Denials Due to Lack of Medical Necessity A medical provider has received an insurance denial due to lack of medical necessity. To review the correctness of this action, the provider’s office obtains the carrier’s policy definition of medical necessity. . . . more >> Hospital Replaces Rebills With Appeals CASE STUDY: Rebilling unpaid claims at 60 to 90 days has long been a rule of thumb in medical receivables management. However, a California hospital has found a much more appealing method of handling aged claims that resulted in an immediate drop in aged accounts. . . . more >> Increase Pay-up by Successfully Appealing Claim Denials Learn why perseverance is the key to a high rate of overturned medical health insurance appeals. . . . more >> CASE STUDY: Appealing Denials Based on Verification of Preauthorization of Coverage At the time of patient admission, the Provider called the Insurance Company to verify policy benefits. An insurance representative confirmed that coverage was currently in effect and provided coverage details. . . . more >> Never Talk to the Monkey When the Organ Grinder is Available Insurance companies receive, review and uphold thousands of medical appeals each year. Should you be detered if you receive a letter stating your appeal letter was reviewed and the decision to deny payment was upheld. . . . more >> Another Day in the Paradise of Managed Care Reimbursement It has happened again... another reimbursement check and Explanation of Benefits (EOB) has arrived from a Managed Care Organization (MCO) with an amount less than what you believe is due to you under your MCO agreement. What do you do now. . . . more >> More Headlines Username: ...