eNewsletter: Reimbursement eNewsletter for the healthcare community

ISSUE 55 Oct 22, 2008

















Assisting Your Out Of Network Patients with Network Inadequacy Appeals
Network adequacy/access to specialist standards are designed to make sure that health plans have an adequate network of providers within a specific geographic area and sufficient specialty care providers to provide quality care. These regulations often specify. . . . Read this article >>
AppealLettersOnline Featured Resources has more extensive information on network adequacy appeals and hundreds of appeal letter templates for this type of appeal.  See the topic area Medical Necessity Appeal Component Two: Cite Regulatory and/or Compliance Information for more complete information and letter access.  New letters now available under this Topic area include:
  • Arizona Access Plan
  • Minnesota Standing Referral Law
  • Ohio Access Plan
Existing letters for appealing lack of innetwork availability and direct access/standing referral are available for other states. Access these letters >>
5 Sentences To Improve Your Appeal Letters
We hope you received this week’s e-mail about new resources added to AppealLettersOnline. Our redesigned site now provides a comprehensive online manual for appeal success and includes a number of resources and mini training sessions for you to implement for staff training and appeal development purposes.

Our slideshow, 5 Sentences To Improve Your Appeal Letters focuses on immediate changes you can make to strengthen any appeal letter. Members have free access to the slideshow which can be reviewed for your own appeal letter improvement or used for your organization’s staff training. The presentation discusses how to establish your right to a quality appeal, what to seek to assure a quality appeal review and how to demand disclosure of pertinent denial details. Further, 5 Sentences To Improve Your Appeal Letters can be customized for your specific needs and presented by Appeal Solutions' President, Tammy Tipton via phone or in-house. Our customized presentations always include 10 – 20 customized appeal letters specific to your organization and a comprehensive discussion of how to most effectively appeal your denials. Email Tammy Tipton at to describe your customized training needs and receive a quote for a presentation to your organization.
View this slideshow presentation >>