eNewsletter: Reimbursement eNewsletter for the healthcare community

ISSUE 49 March 12, 2008




Obtaining Correct Benefit Information Prior to Treatment
Most healthcare organizations supplement online eligibility information by verifying benefits over the phone.  Unfortunately, carriers routinely warn that benefit information obtained over the phone is "not a guarantee of payment."  One way to obtain more accurate benefit information is to take the verification of benefits process "one step further" by demanding Benefit Clarification Disclosure.
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AppealLettersOnline Featured Letter has added a letter to assist subscribers with seeking benefit disclosure prior to treatment. See the new letter entitled "Pretreatment Request for Benefit Disclosure" under the Appeals Repository Topic, "Information Requests" and the subcategory, "Pretreatment Benefit Disclosure." Also, see the range of state-specific disclosure letters under the category, "Benefit Reductions" and the subcategory, "State Mandates."
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Customized Appeals Training Appeal Solutions provides customized training on how to use your state utilization review laws and ERISA protections to demand prompt, professional precertification and verification of benefits.

Because precertification and/or verification procedures vary significantly from provider to provider, we will tailor denial avoidance training to meet each client’s unique challenges. Our Customized Denial Avoidance Training is presented by phone and web presentation to your staff only to allow the entire presentation to focus on your staff’s pretreatment process. The entire 90-minute presentation will be designed to address the verification and precertification issues unique to your organization and will include numerous sample letters and tracking tools to allow you to demand the carrier's compliance with state and federal law.

Read more about this training program...